Survey: Providers need better cost analytics tools for payments
As healthcare providers shift away from fee-for-service toward value-based payment models, they're hitting some serious roadblocks – one of them being that the majority of them lack sophisticated IT tools and analysis to support these new models.
At least that's according to a survey conducted by audit, tax and advisory firm KPMG, which gauged where healthcare provider organizations stood in regards to their finance capabilities. The big takeaway? The lion's share of providers – 74 percent, in fact, are either undeveloped or still in the beginning stages of developing departmental contract analysis support. Only a paltry 15 percent said they have "very sophisticated" capabilities to support these payment models.
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"It has never been more crucial for providers to prepare their finance departments to address the demands that new care delivery models, such as accountable care organizations and alternative payment arrangements, will present as the industry moves away from fee-for-service reimbursement mechanisms," said Joe Kuehn, advisory partner at KPMG's healthcare & life sciences practice, in a press release announcing survey findings. With this uptick in financial risk, he added, "finance departments will need to prepare to manage these challenges and have better systems to measure performance against established targets including the cost and quality of care for example, so they can manage in this new environment."
And this new environment is fast developing, with the Centers for Medicare & Medicaid Services having set a goal earlier this year of having 90 percent of Medicare fee-for-service payments in a value-based payment model come 2018.
With this goal on the horizon and the reporting requirements to keep track of, finance departments are looking for more sophisticated IT tools and platforms to help them with federal quality reporting requirements and capabilities. Top of the list, according to survey respondents? Some 30 percent of healthcare providers surveyed by the firm said they first need predictive modeling to identify both financial and clinical trends.
Next on the list at 27 percent was analytics that support performance reporting and these payments models – think quality-based payments, bundled payments and capitation. Other significant needs were listed as organizational and/or cultural changes at 12 percent and showing the connection between quality and incentives at 10 percent.
When asked about departmental integration – that is, how integrated is your finance department with operations? – most providers indicated it was the middle of the road. Just over 42 percent of those surveyed indicated their integration was "somewhat," with contracting support and some performance reporting. About a quarter of providers said both departments are "very integrated," and another 27 percent said it's either separate and siloed or limited.
Graph data from KPMG 2015 survey