Health systems have been working hard to lay the foundation for taking on a larger case mix of value-based contracts. 75% of health systems surveyed said they are ready to accept downside risk in the next two years, up from 42% in 2015. As health systems are discovering, value-based care reimbursement is more complicated and requires a new level of specificity in documentation. The question is, are health systems really ready to take on downside risk while continuing to manage FFS contracts?

Today we have Kyle Swarts, Chief Growth Officer, and Matt Lambert, MD, Chief Medical Officer from TrustHealthcare to help us answer that question. We discuss challenges and opportunities facing health systems as they embrace the shift to value. Enjoy!

Highlights from Headwinds Impacting the Shift to Value-Based Care

  • It’s time for providers to take on risk.
  • Everyone has a population health department but fee-for-service is still driving your overall strategy.
  • The threshold for making the jump to VBP.
  • Why it’s so difficult to get doctors on board with VBP.

It’s not how sick your patients are, it’s how well you document how sick your patients are.

  • The risk of moving slowly to VBP.
  • The promise of 60 minute home visits with a physician finally has a reimbursement model.
  • Where we will see new consolidation in response to VBP.
  • The two big reasons specificity in documentation is key to successful downside risk contracts.
  • Reimagining EHR design to foster VBP.
  • AI success is all about physician adoption.

Kyle Swarts, Chief Revenue Officer

Kyle is a growth-minded leader who has overseen sales, marketing, and business development at healthcare consulting, revenue cycle management and information technology companies for the past 12 years.

Matt Lambert, MD, Chief Medical Officer

Matt brings over twenty years of experience as a clinician, CMIO, and change leader to value-based care, ensuring that patients receive more comprehensive care and that payers and providers better capture the value of their services.

Founded in 2018 by a team of healthcare veterans and clinicians with private equity funding from Windrose Health Investors, TrustHealthcare’s mission is to empower healthcare provider organizations and health plans to successfully navigate from fee-for-service to value-based care. The TrustHealthcare platform seamlessly integrates with the electronic health record and leverages more than 500 proven clinical rules – while also connecting CDI specialists, clinicians, and coders in one simplified workflow. With TrustHealthcare, providers and health plans can rest assured that they are capturing the full value of patient care in real-time.

Links and Resources

TrustHealthcare Website

TrustHealthcare Linkedin

Unrest Insured by Matt Lambert, MD

A Primer on HCC codes and Risk Adjustment

Related Episodes:

Top 10 Things to Ensure Success in a Value-based Healthcare World

Value-based Payment: Progress, Trends and Direction w/ Jason Helgerson

The Future of Value-Based Payment w/ François de Brantes of Remedy

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