By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    improving patient experience
    6 Ways to Improve Patient Satisfaction Within Hospitals
    December 1, 2021
    degree for healthcare job
    What Are The Health Benefits Of Having A Degree?
    March 9, 2022
    custom software development is changing healthcare
    Digital Customer Journey Mapping and its Importance for Healthcare
    July 21, 2022
    Latest News
    Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
    May 16, 2025
    Learn how to Renew your Medical Card in West Virginia
    May 16, 2025
    Choosing the Right Supplement Manufacturer for Your Brand
    May 1, 2025
    Engineering Temporary Hospitals for Extreme Weather
    April 24, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Can Thinking Younger Make You Live Longer?
    April 20, 2011
    Image
    Obesity’s Outlook Unchanged
    June 13, 2011
    When It’s An Emergency Elderly Not Treated As Well in Hospitals
    July 16, 2011
    Latest News
    Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
    May 18, 2025
    The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
    May 14, 2025
    The Backbone of Successful Trials: Clinical Data Management
    April 28, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Why Hospitals Need A Performance Program Officer
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > Why Hospitals Need A Performance Program Officer
FinanceHospital Administration

Why Hospitals Need A Performance Program Officer

tkilpatrick
Last updated: March 10, 2014 9:11 am
tkilpatrick
Share
5 Min Read
hospital performance program officer
SHARE

hospital performance program officerHospitals, like other businesses, have become successful managing a discrete service for a predetermined reimbursement. It could be an inpatient stay, emergency room visit, outpatient clinic visit or other services.

hospital performance program officerHospitals, like other businesses, have become successful managing a discrete service for a predetermined reimbursement. It could be an inpatient stay, emergency room visit, outpatient clinic visit or other services.

Soon, this model will be turned on its head with the implementation of performance programs (see 8 Performance Programs That Will Change Healthcare). For hospitals or healthcare systems to be successful, they will need to successfully manage to an “episode” or “12 months of care”.  It will require transforming an entire business from managing services over “30-60 minutes” or “a few days”, to managing patients within performance programs over “a few months” or “a year”.

It will require new capabilities, technologies and relationships.  It may seem like several years off, yet if Medicare begins incentivizing beneficiaries to join Accountable Care Organizations (ACOs) in January 2015, it may be only months away.

More Read

Why Clinicians Need to Embrace Their HIT Teams
The Price, Cost, and Value of Bio-Pharmaceutical Care
Is the Hospital of the Future Not a Hospital at All?
The Diagnosis That Could Have You Paying an Extra $40,000 Per Patient
Engaging Specialty Practices in the Patient Centered Medical Neighborhood

I recently met with the CEO of a healthcare system that was piloting two of the 8 performance programs. He stated that they did not have the internal resources to engage in a third performance program.  Yet in 2-3 years, they may need to manage 20-25 performance programs.  They may need to manage each of the 8 different performance programs with multiple variations for each payer.  An example would be running an ACO with separate contracts with Medicare, Medicaid and three different commercial insurance companies.

While hospitals cannot afford to take their eye off the ball of what is happening inside their 4 walls (like ICD-10, reimbursement pressures), they need to develop a performance program capability.  To get on track with the transition from fee-for-service to value-based care, a Performance Program Officer would be dedicated to developing each of the following:

Performance Program Management Office – Develop a common framework to manage each of the 8 types of performance programs. Develop strategy, organizational structure and governance, operations, partnerships, information technology platform, finance and third party administration to adjudicate gain share arrangements. Ensure legal and regulatory oversight. Develop contracts with payers, providers and service vendors.  Understand the patient populations within each program. Secure patient participation authorizations.  Develop cash flow protection and risk management to enable investing in upfront resources (remote monitoring, care management) for potential gain share reimbursement payments coming 6-8 months later.

Provider Network – Develop a provider network by leveraging an existing Integrated Delivery Network Independent Practice Association (IPA), large physician practices or health plans.  Align incentives, build relationships and set up performance reporting.

Utilization Management – Set up the capability to ensure the patient is getting the right services for the right price, preferably within the provider network.   Managing medical necessity within pre-negotiated provider networks are capabilities that providers will need to learn from health insurance plans.

Marketing – Patients, physicians and employers will likely have options for who will manage their care over “a few months” (orthopedic and heart surgeries bundled payments) as well as over “a year” (ACOs or Patient Centered Medical Homes).

Relationship Management – Physician relationship management will be critical as physicians will retain referral options even with a performance program arrangement. Direct relationships with patients will be important to ensure overall satisfaction (to create brand advocates) and minimize leakage, when patients end up in a hospital Emergency Room outside the performance program network.

Business Development – reach out to employers, labor unions, benefit consultants, insurers and other at risk entities (i.e., offer a bundled payment to a local ACO).  They will be each be evaluating how to get the most effective and efficient healthcare.

Analytics – ability to combine historical insurance claims data with patient electronic medical records from the hospital and physician practices. Develop performance analytics and reporting by patient type, providers, utilization, conditions (i.e., Heart Failure, Pneumonia), recovery protocols and recovery results.

Patient Programs – Patient registry that identifies each patient within each of the performance programs and a process to identify them when they arrive.  Integrate a Health Risk Assessment as well and Care Transition (i.e., Hospital to home) program into the delivery process to help determine the most effective recovery plans.  Build programs for Patient Recovery after an acute care visits, adverse chronic events, and for patients managing chronic conditions.

(performance program officer / shutterstock)

TAGGED:performance programs
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Clinical Expertise
Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
Health care
May 18, 2025
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Health
May 15, 2025
Learn how to Renew your Medical Card in West Virginia
Learn how to Renew your Medical Card in West Virginia
Health
May 15, 2025
Dr. Klaus Rentrop Shares Acute Myocardial Infarction heart treatment
Dr. Klaus Rentrop Shares Acute Myocardial Infarction
Cardiology
May 13, 2025

You Might also Like

Affordable care act
BusinessFinanceHealth ReformHospital AdministrationPolicy & LawPublic Health

The Trials of Progress in the Affordable Care Act

May 21, 2013
icd-10 preparation
BusinessFinanceHospital Administration

ICD-10: Where Do We Go From Here?

February 2, 2015

Delivering Collaborative Breast Cancer Care in the Oncology Medical Home

October 21, 2012
Baby Doc
Hospital AdministrationMedical Education

A Nurse’s Letter to the Interns

March 17, 2016
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?