By Amber Molina

The healthcare industry is going through a period of unprecedented change, and decision makers are stuck with their feet in two canoes -- one heading towards service-based payments and one towards value-based care. These competing priorities can make it difficult to know where to focus initiatives and direct employee efforts. Too often, band-aid solutions are put in place to temporarily mask issues -- band-aids that can actually cause a hospital to lose money.

The solution can be found by creating holistic patient and provider profiles to bridge the gap between service-based reimbursements and value-based care. Integrating demographic and socioeconomic data with billing information, EMR data, and other clinical information creates multi-dimensional profiles that promote action and change.

Here are 3 ways organizations can stop wasting money and start growing profitably in the age of value-based care:

Maximize incoming referrals

One of a health system’s largest sources of revenue is through referrals from specialty clinics and physician groups. Unfortunately, it’s often only through manual engagement and communication that these referring physicians are tracked, managed, and communicated with. With no ability to track referral metrics and sub-optimal referral opportunity management processes, hospitals are left with no way to continually engage and increase the number of these specialty referrals.

Correctly managing specialty physician relationships can help increase referrals and opportunity wins. This means more 1:1 engagement and communication to drive proactive action and follow up on clear KPIs and referral goals. 

Increase care coordination efforts

With the rise of consumerism in healthcare and the fact that more patients are seeking alternative wellness strategies, traditional healthcare providers are left wondering how to provide value-based quality care to patients outside the four walls of a hospital. Care coordination solutions help organizations care for, engage with, and better serve large patient populations across various stages of the healthcare continuum.

With multi-dimensional solutions and tools, healthcare leaders can analyze metrics and reports in real-time to see what patients are receiving the most care, where employees are spending the most time, and how many cases are being resolved during a certain time period. Leaders can also validate and explain high-dollar investments and campaigns.

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Optimize bundled payment strategies

Today’s health systems, hospitals, and post acute care facilities are being tasked to decrease patient length of stay, effectively keeping patients healthier and out of care treatment facilities. This means tracking the overall cost per patient, per treatment, and per length of stay -- all in a single, holistic platform for complete visibility. All key stakeholders from inside or outside the treatment facility should have access to critical issues and changes.

Having access to these clear, actionable patient profiles allows healthcare leaders to understand exactly how their business is operating. Directors can view patient metrics at specific referring locations or by certain ordering or CPT codes and then take this information back to payors and physicians to increase reimbursements and incoming referrals.


Your health system can take proactive steps towards reducing revenue leakage by implementing a holistic healthcare relationship management solution to help track and manage all aspects of healthcare operations. Stop by booth 26 at the Becker’s Annual Conference to see these hc1.com solutions in action.

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