Competency Area #4: Develop and implement financial models that promote provider and staff buy-in and advance the achievement of quality benchmarks, appropriate utilization of care, and long-term organizational sustainability
The key elements that comprise Competency Area #4 are outlined below. These can be used as touchpoints in determining whether your TA project helps advance your ACO or CP in this competency.
Performance evaluation and management: ACOs and CPs bring together financial, actuarial, quality, and clinical leadership expertise to ensure that targets, benchmarks, and measurement strategies are established in a manner that enables them to improve health outcomes and member experience, decrease total cost of care, measure success, and ensure sustainability over time.
Incentive models: ACOs and CPs design incentive and other value-based payment models that successfully engage provider entities, and care team members in the transition from fee-for-service to value-based payments in order to ensure cohesive implementation of organizational strategies for improving health outcomes and member experience, decreasing total cost of care, measuring success, and ensuring sustainability over time.
Organization-wide adoption of financial models and business practices: ACOs and CPs implement and provide support for the adoption of financial models and related business practices, including billing and coding standards, across all provider entities to ensure that all business activities are implemented in a manner that advances organizational strategies for improving health outcomes, member experience, and access; decreasing total cost of care; measuring success; and ensuring sustainability over time.
[For CPs only] Prepare for participation in value-based payment models: CPs develop and utilize financial forecasting tools and strategies, implement new quality and outcome monitoring protocols, and build population health approaches in preparation for participation in value-based payments and risk-sharing relationships with ACO partners.
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