Pandemic Response

In pressing times like these, the health care community must come together. The immediate urgency that the COVID-19 Pandemic has placed on our delivery system's infrastructure is both mounting and innately unpredictable. Hospitals are seeing short-term cash deficits escalating nationally with very few exceptions. But there are innovative operational solutions that any hospital, with the right team, can implement today.  

Solution 1: Leverage Public Support to Create Solutions with Payer Partners 

Sentiment from the public for front-line health care providers is at an all-time high and open dialogue with Commercial Payers is critical. To have educated conversations with your Payers today, it's vital to have an informed understanding of your contracts' baseline. That means knowing where the contracts compare within the market, to each other, and Medicare. Aligned response efforts and market-specific projections in collaboration with Payer Partners will serve the community better and provide much-needed guidance for patients.

The ask for Payers includes, but is not limited to:

1. Minimizing revenue cycle administrative friction
2. One-time or annual rate increases
3. Forgivable loans earmarked specifically for Pandemic response
4. Investment in expanded clinical delivery such as Telehealth development

It's critical to know where payers can make concessions and produce massive cash infusions to invest in Solution 2 (see following.) It is also imperative that your team understands how the political climate is increasingly in favor of the nation’s hospitals and providers.  

Solution 2: Assess Existing Volume and Increase Share Through Referral Management 

With COVID-19 causing many organizations to become paralyzed, there will be an opportunity for market share to shift and for systems to re-prioritize service lines. Organizations that proactively pursue growth in competitive markets will have opportunities to gain new specialists/patients, and organizations that do not will be in serious jeopardy. 

A key component of winning the new markets for elective procedures and delayed surgeries due to COVID will be ensuring a robust referral management system. New CMS waivers have changed the landscape and can incentivize surgeons to maintain care within your network.

Hospitals that are winning market share with strong referral management do the following:

1. Examine profitability/margins by service line to know what volume to expand vs. negative contribution margin to manage
2. Utilize CMS ACO or commercial risk participation to establish CMS Waiver for network retention incentives
3. Analyze CMS ACO or commercial value/risk-based claims data sets to evaluate existing patient flows and network retention drivers
4. Understand genuine opportunity vs. Out of Network referrals to geographic or service access the network doesn't provide or include
5. Establish new network retention expectations and incentive models
6. Implement industry-leading scheduling capabilities and same-day access with end-user friendly scheduling tools

It may often not feel like a moment of opportunity, but the Pandemic is just that. Change is happening faster than anyone predicted.  Your team can embrace that change to lead your institution and community in this time of unprecedented public health needs. 

Cogent specializes in Commercial Payer collaboration and negotiations and is uniquely positioned to assist with a Rapid Remote Managed Care Assessment, which can be conducted in 10 days utilizing primarily readily available reports and data. We have assisted clients manage strenuous negotiations, with both local and national plans, leveraging public perception and acquiring critical rate increases that enable continued improvements to care delivery. Our client’s typically see a 7x plus return on investment when working with us.

If you would like to discuss this opportunity further, please let us know and we can schedule time at your convenience to better understand your unique situation, walk through the process and answer any questions you may have.