Introducing FTI Consulting's Market Maturity Model for a Risk-Based Ecosystem
The advent of value-based care, based on the Triple AIM: improving the individual experience of care, improving the health of populations and reducing the per capita costs of care has pressured providers to shift their focus from volume to value. And, as providers shift to value-based activities, their reimbursement model has also become more in alignment with payers. Like payers, providers now benefit from a fundamental understanding and ability to manage risk.
Going at risk presents multiple financial opportunities for provider groups. As providers take on more accountability for patient care in exchange for greater reimbursement, they should understand the degree of risk sharing associated with alternative business models.
The FTI Consulting Market Maturity Model identifies six critical success factors - contracting and physician engagement, operations and analytics, member engagement, care models, compliance and financial acumen – essential to a value-based care environment. Each of these factors have 3-5 focus areas across the continuum.
Realigning and redesigning a provider group to incorporate more sophisticated tools that payers employ means more than modifying compensation contracts. Investments in analytics and operational changes are required to ensure provider groups have better visibility into what is happening within the entire team -- with patient health, within their provider operations, and within their financials – their bottom line. And to achieve excellence some organizations might choose to add experienced staff to ensure organizational functions are aligned and prepared for a great performance.