How Does Value-Based Care Revenue Cycle Management Affect Healthcare Providers?

In a rapidly changing healthcare landscape, value-based care revenue cycle management (VBC RCM) is an increasingly critical concept for many organizations. This focuses on the arrangements and payable activities of the patient life cycle, providing high-quality service within a low-cost system. The results of VBC RCM prove it decreases administrative burden, enhances efficiency, and boosts reimbursements while delivering better patient outcomes.

Healthcare organizations can drive cost savings through VBC RCM, which also increases transparency into the various cost structures within the system, facilitating the streamlining of processes related to the services provided. In this article, we will explore how VBC RCM affects healthcare organizations with respect to finances, operations culture, staff morale and customer satisfaction.

Value-Based Care Overview Revenue Cycle Management

In value-based care, patient outcomes take precedence over the volume of services delivered. It differs from the traditional fee-for-service healthcare model, where healthcare professionals are compensated for the number of services they provide.

Clinical and financial aspects of patient care are the same across most settings; for instance, in an ambulatory/outpatient setting, Revenue Cycle Management (RCM) is managing every aspect from first contact with a patient to receiving payment of services rendered or debts incurred. RCM consists of everything from scheduling appointments to insurance verification and billing and collections.

What are the advantages of value-based care RCM management?

Both value-based care (VBC) and healthcare revenue cycle management (RCM) have incredible benefits for patients.

Patient’s favorable outcomes 

Hence, VBC RCM is more about getting better patient outcomes and, in return, creating excellent experiences for them so that the patients are happy. By putting a greater focus on preventive care and streamlining the way in which that care is delivered, VBC RCM can raise standards of patient treatment, leading to enhanced health outcomes.

Reduce Administrative Workload 

You can reduce the administrative burden that VBC RCM imposes on patient care. It can also save money and time for healthcare organizations, providing reimbursement on time by fixing processes.

Spend Less

A VBC RCM offers an incentive for healthcare providers to perform more preventive care and reduce the frequency of costly medical procedures and hospital stays. This has the potential to reduce costs for both patients and healthcare providers.

Better Performance on the Financial Front

4018514 It can improve financial performance by boosting cash flow and cutting down on administrative expenses. VBC RCM also ensures timely and accurate payments, maximizing healthcare organizations’ incentive for their revenue potential.

Enhanced Revenue

RCM allows healthcare providers to receive full payment for the services they provide. Effective use of revenue cycle management enables healthcare providers to decrease denied claims and boost overall revenues.

Enhanced Productivity

The VBC RCM necessitates meticulous coordination and management of care delivery. It can improve efficiency by eliminating duplicate or superfluous processes, reducing administrative overhead, and ensuring that patients receive the right care at the right time.

The Power of Data-Driven Decisions

Therefore, VBC RCM relies on data collection and analysis to pinpoint every area for care improvement. Through data analytics, the healthcare service provider can make insightful decisions regarding patient care and revenue cycle management.

What does VBC Revenue Cycle Management include?

Some key elements of value-based care models and revenue cycle management (RCM) are as follows:

Patient Identification and Eligibility Determination

VBC RCM, which is a license for healthcare organizations to improve patient outcomes, reduce costs and earn more. In order to make the RCM process go as smoothly and effectively as possible, it must begin at the point of care with providers identifying patients eligible for value-based programs and verifying their eligibility through insurance checking. We can rely on it to make better decisions without jeopardizing the quality of care or overstretching assistance, while simultaneously alleviating administrative responsibilities such as patient scheduling, billing, and patient payment issues through data analytics.

Care Coordination

Making sure the patients receive their care on time and at their place of residence requires a tremendous deal of collaboration between multiple healthcare providers, as mandated by VBC RCM. Care coordinators can also facilitate communication between providers, help with appointment scheduling, and offer patient support during more challenging stages of their journey.

Quality Measures

VBC programs frequently use quality measures to monitor patient outcomes and ensure that healthcare workers render high-quality care. To successfully participate in programs, providers must collect and report on these measures. It can also be used to identify areas for improvement and streamline care delivery.

Claims Processing and Reimbursements

Healthcare providers must process claims in VBC RCM efficiently and accurately to receive prompt reimbursements. Healthcare providers must validate claims, send them to insurers, and chase denials or rejections. Automated systems may speed up the claim processing process and reduce administrative costs.

Care Management

Successful VBC RCM requires effective management of care delivery. Such measures include using only evidence-based, quality treatments and following performance data to outline priorities for improvement. Healthcare organizations can work with care managers to create plans for efficient care coordination while maximizing program reimbursement.

Financial Management

For healthcare providers to have effective cost management, VBC RCM requires financial accountability. It encompasses revenue and expenditure tracking, performance analysis, and adequate compensation for services rendered. Providers can use data analytics to find areas in which financial management is lacking.

Analysis and Reporting

VBC RCM uses data analytics to identify areas for improvement and boost the quality of care. Health care providers must capture, analyse and report data relating to patient outcomes, quality measures, and financial performance.

Issues with Implementing Revenue Cycle Management for Value-Based Care

Healthcare providers often face many hurdles when switching to VBC RCM. It requires a complete rewrite of business processes and a shift in perspective from the administration management aspects to the patient perspective. The following are some of the main challenges to VBC RCM adoption:

Able to Resist Change

The primary obstacle to the adoption of value-based care (VBC) and revenue cycle management (RCM) is the resistance to change. There are also providers who may be reluctant to break free from conventional fee-for-service models, thus not willing to spend on the infrastructure needed for value-based care revenue cycle management (VBC RCM).

Complicated Regulations

A lot of the VBC programs come with rules and requirements that are extremely convoluted, which makes it difficult for healthcare providers to wrap their heads around. It is time- and resource-intensive for providers to comply with different quality measures, reporting rules and payment models. This puts extra pressure on already overloaded healthcare organizations.

The Use of Technology

In order to be effective, VBC RCM leverages multiple technologies, such as electronic health records, revenue cycle management software, and data analytics tools. This poses challenges to integrating these technologies, particularly for smaller healthcare providers with limited resources. Implementing this technology can be costly and can delay the transition to VBC RCM.

Managing Data

VBC RCM relies on healthcare providers to collect and analyze data about patient outcomes, as well as the quality of care delivery and financial performance. It necessitates a complex data management flow, which is difficult to follow in real life. Moreover, the various systems seldom jive together, which makes it impossible to manage and share data effectively.

Involvement of Patients

Physicians and other healthcare providers must involve patients in their own treatment. This can include providing educational and informational tools, as well as ensuring patients have access to the resources they need. Personalized care can lead to better outcomes and lower costs.

Exposure to Financial Risk

 Because providers receive payment based on the quality and outcome of the program rather than the number of services rendered, VBC programs are often a dangerous financial gamble. Such a change can be difficult for providers practicing fee-for-service, and they may not want to take on the new financial risk.

Tips to Improve Revenue with VBC Models

To boost outsourcing revenue cycle management in value-based care (VBC) models, healthcare providers should focus on the following strategies:

Identify High-risk Patients

Identifying the highest-risk patients is a major strategy for maximizing revenue in value-based care (VBC) models. Finding the right patients has significant implications, as treating these high-cost groups can lead to better outcomes and fewer expensive medical interventions.

Care Delivery Optimization

Successful VBC models focus on patient preventive care and continuum of care delivery coordination. Providers should analyze data to identify areas for enhancing care while also accommodating patient voice in determining quality improvement practices, which can lead to decreased costs and improved outcomes.

Favor Quality Care

We need to reward these organizations for quality, not for the number of services per unit of care. This might mean paying providers in part for achieving specified performance goals or providing bonuses to individual employees who hit specific targets. This can ensure that healthcare providers are more efficient in delivering cost-effective yet high-quality healthcare services.

Make Technology Investments

The widespread use of technology enables providers to manage data, track outcomes, and coordinate care management for value-based payment models. Invest in technology that supports VBC models: Healthcare providers should invest in technologies and IT solutions to support these types of value-based care delivery businesses, including software for revenue cycle management (RCM), electronic health records systems, data analytics tools, etc. This means healthcare will be paperless, and providers can maximize revenue under VBC models.

Handling Quality Measures

Healthcare providers are required to report on several quality measures, which many VBC models rely on. Therefore, providers must regularly monitor these measures to identify areas for improvement and optimize performance under value-based care (VBC) programs. It can also help ensure other providers you use are meeting quality metrics and driving more revenue.

Consolidate Revenue Cycle Management

Revenue cycle management healthcare that works well is an essential part of revenues under VBC models. Therefore, healthcare providers must simplify the revenue cycle management processes to reduce administrative workload and prevent claim denials or rejections. A system like this will guarantee prompt payment to providers and maximize their revenue through VBC models.

Patient Follow-Up

 Healthcare providers must follow up with patients on a regular basis, monitor their progress, and provide all necessary care. This can help providers identify and resolve potential issues upfront, leading to better patient outcomes at a lower cost.

Explore More with Velan!

With decades of experience in accelerating payers and providers alike, Velan focuses on empowering our nation’s healthcare providers to fully utilize the power of VBC models to maximize reimbursement potential. Using our efficient healthcare RCM services and data analytics tools, healthcare organizations can optimize their processes for better throughput under VBC programs. Contact us today to learn how VBC models can help your organization maximize revenue.