Clinical Co-Management

In today’s post-reform healthcare environment, providers must navigate not only the turbulence caused by the transformation of our healthcare delivery system, but also the migration of both governmental and commercial payers towards the value-based purchasing of healthcare services. Every week it seems that new pilots are being launched to test next generation reimbursement models like Bundled Payments and Accountable Care Organizations (ACOs). While the ability of these models to rein in healthcare costs remains to be proven, most indicators suggest that providers should expect to share financial risk for the care that is delivered to patients across providers and sites-of-care.

One proven option for health systems, hospitals, and provider organizations that are beginning a journey towards Accountable Care is Clinical Co-Management. Clinical Co-Management is a hospital or health system funded pay-for-performance program that compensates physicians for taking a more active role in the day-to-day oversight of their service-line and holds them financially accountable for the service-line’s overall performance in regards to a balanced scorecard of measures typically including: quality of care; operational efficiency; service line development; financial performance; and alignment. Clinical Co-Management fosters a mutual interest amongst physicians and hospital administrators to increase the value of services provided to patients by reducing cost while simultaneously improving the quality of care delivered to the community.

Unlike the broad scope of the ACO model, the Clinical Co-Management model typically focuses on a specific service line (e.g., Cardiovascular, Orthopedic, Oncologic, Neurologic, and General Surgical Services) and, as such, may support a healthcare organization’s transition to Bundled Payments or serve as a pilot for more ambitious initiatives like full Clinical Integration or ACO development.

Setting out on the path to shared financial risk can be intimidating but our Healthcare Consultants can help you find sure footing as your organization takes its first steps.

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ACO, Alternative Care Organizations, Healthcare Consulting