与成人医院和bet8网站备用相比,儿童医院和bet8网站备用一直面临着独特的挑战. These advanced systems are often located in high-cost, 主要的人口中心,并作为目的地复杂, expensive care.
但是今天,儿科组织正面临着一系列新的挑战和战略问题. For many systems, 由于费用不断上涨,财政压力不断增加,他们履行为所有儿童提供专门照顾的使命的能力受到了质疑, the availability of price transparency data, a growing Medicaid payer mix, and downward pressure on commercial reimbursement.
At the same time, operational challenges such as inadequate care access, provider and staffing shortages, lack of downstream providers, administratively burdensome payer policies, 产能限制加剧了财政困难. Pediatric systems are also facing new clinical demands, 包括对综合行为健康bet8娱乐和先进护理管理能力的空前需求.
这些压力汇聚在一起,导致儿童医院和bet8网站备用重新评估其战略规划的必要性,同时重新强调综合业务, financial, and managed care strategies. There is no one-size-fits-all strategy, 因此,每个儿童教育系统都必须根据当地的动态调整自己的方法, current market positioning, operational challenges, and strategic goals.
To begin this process, ECG建议儿童医院在三个关键领域评估其当前定位和未来战略:
- Market dynamics and pressures
- Reimbursement structure and rates
- Value and risk adoption
Market Dynamics and Pressures
儿科系统在制定策略时需要考虑当地的市场动态. This includes shifting consumer enrollment and demand, the availability of a downstream providers, and state Medicaid policies. 下面图1中列出的问题将帮助儿科系统超越其直接组织,考虑影响其业务的无数外部力量.
For instance, ECG与一家一流的儿童医院合作,制定了定价和市场参与策略,以弥补常规的损失, but mission-critical, service volume to competitor organizations. To ensure a data-driven approach, 心电图进行了全国比较分析,了解相对定价, clinical approaches, quality, utilization, 以及其他三级和四级医疗bet8娱乐提供者的财务结果. This market intelligence, 结合对组织现有优势和能力的理解, created a foundation for its revised strategic plan.
Figure 1
Reimbursement Structure and Rates
With an understanding of the external environment, 然后,组织应该向内看,评估现有的管理式医疗和财务战略是否与市场机会和组织目标相一致. 图2中列出的问题可以作为此分析的基础. However, 重要的是要记住,这些问题的答案和由此产生的策略是高度个性化的, and no two organizations will follow the same approach.
For instance, 利润率下降导致北方一家大型儿童医院聘请ECG来分析付款人合同和市场参与度. 由此产生的建议集中在关键战略上,其中包括集中提高较少购物bet8娱乐的付款人费率, developing a targeted out-of-state Medicaid strategy, 优化当前的以价值为基础的医疗参与. However, 对南方另一个儿童系统的类似分析得出了不同的建议——包括修改付款人参与策略, 组织和文化变革以支持合同终止, and immediate renegotiation of behavioral health rates.
Figure 2
Value and Risk Adoption
Finally, 许多儿科系统想要了解基于价值的护理采用的速度,以及他们是否应该参与这些替代支付模式(如果是的话), to what degree). ECG建议所有儿科组织评估潜在的基于价值的机会,并就正确的安排类型和采用的时机制定组织立场. To start, 通过您的组织的内部能力和当地市场/付款人的需求来考虑图3中列出的问题.
For instance, 中西部的一个儿童医疗系统与当地的bet8网站备用团体建立了合资企业,以便:
- Increase access for Medicaid patients.
- Improve coordination.
- 通过与当地管理的医疗计划建立基于风险的协议,创造财务优势的机会.
In this example, the organization understood the market need, built the corresponding provider network, ensured reimbursement for supplemental services, and created a new revenue stream.
太快冒险可能在财务和运营上都是有害的. 但要有适当的准备和精心制定的量身定制的计划, 这些安排可以改善系统的财务状况,同时提高患者护理的质量和协调. 基于价值的协议的时间和类型因组织而异, 但任何基于价值的战略的重要组成部分都将是使用数据驱动的洞察力来理解可行性, margin impact, and market alignment.
Figure 3
制定一个全面的战略需要儿科系统进行当前的市场分析, assess value-based readiness, evaluate current reimbursement terms, address service gaps, and understand current operations. 儿科系统面临的挑战是独特的,需要创新的解决方案, organizational flexibility, and engagement from all departments and titles.
接下来:我们将仔细研究儿科bet8网站备用是如何接近以价值为基础的护理世界的. 下周请到这里继续讨论.
有关您的组织应如何根据这些和其他考虑因素制定儿科战略的更多信息, contact the team at ECG.
Edited by: Matt Maslin
Published January 12, 2024