HOW SUCCESSFUL ORGANIZATIONS MANAGE RISK
Before taking the leap from P4P/upside to downside risk, it’s important that healthcare leaders understand where the two arrangements diverge. What is the first order of business? Leaders must dispel the main misconception that ramping up quality scores, or succeeding at population health management makes the organization ready to take on more risk.
For example, an organization with a good line of sight on quality metrics and how individual physician practices are performing may flourish under P4P/upside contracting. Downside risk requires granular insights to measure physician performance. Are you prepared to collect the additional data about cost, performance and the myriad global factors beyond your control? Moreover, caregivers across the continuum now require greater insight to do the day-to-day work of helping patients access care efficiently. Are the needed supports and processes already in place to allow care givers to use discrete data for smoother coordination and patient management?