Bill runs a $25 million total joint replacement program that is going through a gut-wrenching change. His business model – the one his entire program is built on – is being turned inside out. In a matter of a few years the big surgical revenues he could rely on in the fee-for-service world are shifting to pay-for-performance.
He’s got to demonstrate that he can hit quality, cost, and satisfaction targets to get paid. That means his revenues are all at risk. He gets paid for doing things correctly and efficiently. He loses big money (and margin) when he isn’t. It’s a scary, unpredictable future for Bill and his CFO. On top of that, he has competition and fears losing market share if payers take their business elsewhere (and they’re all looking the best products at the best price). Plus, he has consumers wanting more choice, more control, and more convenience… otherwise they leave dissatisfied – and that is being measured as part of his performance, too.
In order to survive in this new environment Bill’s got to manage his risks so he can have some assurance of good margin and revenues. He needs to ensure that patients are compliant with the care plans that his teams have designed and standardized. He needs to prevent unnecessary utilization and readmissions. And he needs rapid feedback for continuous improvement of his program to compete with the other hospitals in town.
This story is being played out across hundreds of hospitals and thousands of service lines like Bill’s all around the country as the industry makes the rapid shift to value-based healthcare. A trillion dollars of acute, episodic care spend is going through this transformation. The folks that don’t move to the new business model will get left behind.
Wellbe gives Bill a strategy to maneuver under these new conditions. It provides a standardized, structured program for patients and care teams to follow to optimize patient compliance and staff efficiency. And it provides him actionable data he can use to analyze risk points and measure progress on quality goals. As regulations and payment structures change over time, he’ll have the flexibility to adapt and tackle new challenges without additional resources.