1.12.24
Children’s hospitals and health systems have always faced unique challenges when compared to their adult counterparts. 这些先进的系统通常位于高成本地区, major population centers and serve as destinations for complex, 昂贵的保健.
But today, pediatric organizations are facing a new set of challenges and strategic questions. 对于许多系统, the very ability to fulfill their mission of providing specialized care to all children is in question amid mounting 金融 pressures stemming from rising costs, 价格透明度数据的可用性, 越来越多的医疗补助付款人, 以及商业报销的下行压力.
同时, 运营方面的挑战,如护理机会不足, 供应商和人员短缺, 缺少下游供应商, 行政负担沉重的付款人政策, and capacity constraints are intensifying 金融 difficulties. 儿科系统也面临着新的临床需求, including the unprecedented need for integrated behavioral health services and advanced care management capabilities.
The convergence of these pressures has led children’s hospitals and health systems to reevaluate their strategic planning imperatives while placing new emphasis on integrated operational, 金融, 管理式医疗策略. 没有放之四海而皆准的策略, so each children’s system must tailor its approach based on local dynamics, 当前市场定位, 业务挑战, 战略目标.
开始这个过程, 心电图 recommends children’s hospitals evaluate their current positioning and future strategy in three key areas:
- 市场动态和压力
- 报销结构和费率
- 价值和风险采用
市场动态与压力
Pediatric systems will need to consider local market dynamics when developing their strategy. 这包括消费者登记和需求的变化, 下游供应商的可用性, 以及州医疗补助政策. The questions outlined in figure 1 below will help pediatric systems look beyond their immediate organization to consider the myriad external forces that are impacting their business.
例如, 心电图 worked with a premier children’s hospital to build a pricing and market engagement strategy to offset the loss of routine, 但关键任务, 对竞争对手组织的云顶集团量. 确保采用数据驱动的方法, 心电图 conducted a national comparative analysis to understand relative pricing, 临床方法, 质量, 利用, and 金融 outcomes for other tertiary and quaternary care providers. 这个市场情报, combined with an understanding of the organization’s existing strengths and capabilities, 为修订后的战略计划奠定了基础.
图1
![市场动态和压力](/user_area/uploads/MarketDynamics_1.jpg)
发还款项结构及费率
了解外部环境, organizations should then look inward to evaluate whether existing managed care and 金融 strategies are aligned with market opportunities and organizational goals. The questions outlined in figure 2 can serve as a basis for this analysis. 然而, it is important to keep in mind that the answers to these questions and the resulting strategies are highly individualized, 没有两个组织会遵循相同的方法.
例如, falling margins led a major children’s hospital in the North to engage 心电图 to analyze payer contracts and market engagement. The resulting recommendations centered on key strategies that included concentrating payer rate increases in less shoppable services, 制定有针对性的州外医疗补助战略, and optimizing current upside-only value-based care participation. 然而, a similar analysis for another children’s system in the South led to different recommendations—including a revised payer participation strategy, organizational and cultural changes to support contract terminations, 立即重新协商行为健康比率.
图2
![报销结构和费率](/user_area/uploads/ChildrensHospitalsInvestFigure2.jpg)
价值和风险采用
最后, many pediatric systems want to understand the pace of value-based care adoption and whether they should be engaging in these alternative payment models (and if so, 到什么程度?. 心电图 recommends that all pediatric organizations evaluate potential value-based opportunities and develop an organizational position on the right type of arrangement and the timing of that adoption. 开始, consider the questions outlined in figure 3 through the lens of your organization’s internal capabilities and local market/payer demands.
例如, a children’s system in the Midwest developed joint ventures with local physician groups to:
- 增加医疗补助患者的准入.
- 提高协调能力.
- Create opportunity for 金融 upside through the establishment of risk-based agreements with local managed care plans.
在这个例子中, 该组织了解市场需求, 建立相应的供应商网络, 确保补充云顶集团的报销, 创造了新的收入来源.
Moving to risk too quickly can be 金融ly and operationally detrimental. But with appropriate preparation and careful development of a tailored program, these arrangements can improve a system’s 金融 positioning while enhancing 质量 and coordination of patient care. The timing and type of a value-based agreement will vary significantly by organization, but the vital component of any value-based strategy will be using data-driven insights to understand feasibility, 利润的影响, 以及市场一致性.
图3
![价值和风险采用](/user_area/uploads/ChildrensHospitalsInvestFigure3.jpg)
Developing a comprehensive strategy will require pediatric systems to conduct current-state market analyses, 评估基于价值的准备情况, 评估当前的报销条件, 解决云顶集团差距, 了解当前的操作. The challenges facing pediatric systems are unique and will require innovative solutions, 组织的灵活性, 以及所有部门和职位的参与.
UP NEXT: We’ll be taking a closer look at how pediatric health systems have approached the world of value-based care. Check this space next week for the continuing discussion.
For more information on how your organization should develop its pediatric strategy in light of these and other considerations, 联系心电图组.
编辑:马特·马斯林