So You’re Taking on Risk Now: 3 Tips for Success

It’s hard to take on risk, but you don’t have to do it alone. Your Payers and Vendors are two sources that can help you when you start taking on more risk. Knowing what resources are available to you and knowing how to properly use them can lead to your success. We’re sharing three tips with you to ensure your success now that you’re taking on risk.

 

Engage Your Payer

Talk to your Payer, especially the ones that you get the at-risk population from, about support. Your Payers want to help you succeed in managing their patient populations. Because of this, many of them offer either their team’s support or funding for an external service. Ask and take advantage of what might be available.

Your Payers may provide funding for an external outreach team that specializes in patient engagement. This additional external outreach can help you to better connect with patients and bring them in for the help they need and the services that impact your bottom line.

 

Lower Costs Through SDOH

By engaging patients for preventative or “well care” instead of “sick care” you can save hundreds of thousands of dollars. Moving from Fee for Service (FFS) to Value-Based Care (VBC) and taking on risk means identifying determinants of health. Both physical and social determinants should be addressed, especially the ones that impact the cost of care. These social determinants of health (SDOH) could be food or transportation related and, once addressed, can help patients resolve any underlying issues causing their visit.

How does identifying a patient’s SDOH work in your benefit? One example is what happens when a Diabetes patient runs low on their grocery budget. If they can’t maintain their insulin levels, they may be back in the emergency room seeking care at a higher than necessary cost point. It’s cheaper to make sure a Diabetes patient has a stable, healthy food source than paying for their emergency room visits.

 

Partner with Your Vendors

Ask your vendors to share the risk as well with at-risk pricing. As the healthcare system moves from FFS to VBC, everyone in the chain should take responsibility. There are two things to focus on when creating a successful partnership. The first is identifying and agreeing on clear key performance indicators (KPIs) to success that can be measured. The second is determining a way to track the data that shows the outcomes and whether those KPIs have been met.

If a vendor believes in the effectiveness of their service, they should be willing to take risk alongside the providers. They may be new at developing, implementing and measuring at-risk pricing, so be willing to approach it as a partnership. Be open to experimenting to see what works and make adjustments along the way as you perfect the art.

 

In summary….

When you take on risk, you may need help from internal and external sources. Don’t be afraid to start a conversation with your Payers. They can help you find additional patient engagement resources for you. Look for ways to tackle the social determinants of health that you see with your patients. By addressing the underlying problems your patients may experience, you can keep these patients out of the emergency room and save money. Finally, speak with your vendors. Work with them to create achievable KPIs and determine a way to track those KPIs. They should be willing to share the risk and help you succeed.

 

We help Health Centers, and other Providers to develop strategies to drive patient engagement, lower costs and improve outcomes. To learn more, contact us.