Our client’s need
A post-acute care organization with a multi-state presence signed contracts with managed-care organizations and was approached by several hospitals to participate in risk-based episodes of care for patients requiring short-term inpatient rehabilitation. The client was concerned about whether they had the appropriate culture, technical expertise, and operating processes and structure in place to effectively manage these arrangements, let alone to become a market leader in the emerging post-acute value-based care world of healthcare reimbursement. As such, they asked Baker Tilly to perform a risk readiness review of their organization to identify potential gaps and opportunities to help them prepare for risk-based contracting.
Baker Tilly’s solution
Baker Tilly administered an organizational survey followed by onsite interviews of key senior managers to assess staff perceptions of the client’s risk readiness competency. Survey and interview topics included payer relationships, operational infrastructure, clinical programming, electronic health record (EHR) data capture, reporting and interface capabilities, and market position. Simultaneously, strategic planning sessions with senior management and board level participants took place to understand organizational goals and coordinate resource commitment. Baker Tilly also reviewed the entities financial statements, operational metrics, skilled nursing referral patterns and utilization, and value proposition to understand the client’s financial status and market position in relation to competitors. We also reviewed several existing managed care agreements to assess rates and language.
The client received a comprehensive assessment of their organization including commentary and recommendations regarding critical areas such as payer relations, hospital and other post-acute relationships, clinical programming internal decision support metrics, data interfaces with external entities, and the overall organizational culture. The client also received a road map of action steps to mitigate risk and to position themselves to perform successfully under new value-based reimbursement arrangements.
For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.