Is Your Organization Well Positioned to Adopt Value-Based Care? These 7 Questions Can Help You Assess Your Readiness

June 29, 2015

By Lisa D. Ellis

Lisa D. Ellis, photoIn pursuit of high-quality, cost-effective care that revolves around the patient, many health care organizations seek new ways to foster system-wide collaboration. This concept involves breaking down barriers that have traditionally separated payers, providers, and patients to enable everyone to work more closely together to meet common goals.

Such a way of doing business, commonly referred to as “health care convergence,” also incorporates a major shift from getting paid per service unit to instead getting paid for achieving good outcomes, says Mark Fish, Managing Director, Health Solutions for FTI Consulting.

Mark Fish, Managing Director, Health Solutions, FTI Consulting

Mark Fish, Managing Director, Health Solutions, FTI Consulting

What Is Health Convergence, Really?

“Up until now, you had health groups and clinicians on one end [of the business model] and health plans/insurance carriers on the other end,” Fish says. But he points out that, thanks to the changes brought about by health reform, it has becoming increasingly necessary for these two sides to come closer together and put the patient first. “Now providers will increasingly need to take over some of the insurance responsibilities, while insurers are getting more involved with patients,” he says.

This new way of thinking and of doing business doesn’t come about naturally but requires a lot of preparation. That’s why he and his colleagues work with organizations that want to better understand and apply the concept of convergence, and they also help them figure out how to make this model work within their current reality.

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