Providers struggle to make headway on risk

As payers and employers put pressure on providers to assume more financial risk, providers are struggling to assess the impact of the risk they have already assumed.

According to a new survey by Black Book Market Research, 93 percent of accountable care organizations, hospitals and physicians are facing the challenge of understanding the level of risk they currently have and are foundering trying to figure out how much more risk they can take on.

"Payers and employers are demanding providers to assume greater levels of financial risk for managing the care they deliver to their covered populations, but most hospitals and physician groups don't have the latest staff or technology competencies to be competitive," said Doug Brown, Black Book's president, in a press release about the survey results.

The reason for the difficulties, said Brown, is that providers do not have the appropriate staff or latest technology to provide the competencies to be competitive.

The results are from the first, on financial solutions, in a Black Book series of three reports on ACO infrastructure.

Black Book said it received 106 responses from approximately 400 Medicare ACOs and 718 completed financial services and software evaluations from commercial or Medicare/commercial ACO staff members from 840 hospitals and physician groups.

The survey found that 97 percent of ACO executives said financial solutions are a top infrastructure priority, but only 12 percent of operational ACOs believe they have adequate financial solutions or outsourced services/consulting to be successful in the long term.

78 percent of CFOs said the selection of strategic ACO solutions takes a back seat to revenue management solutions that continue to funnel cash to support fee-for-service reimbursement.

Also, problems with claims data, unstructured governance models, physician recruitment and EHR replacements are slowing down 95 percent of small ACOs and 93 percent of hospitals are late to instituting value-based model strategies in their willingness to take on high-risk contracts. 86 percent of hospital CFOs and 90 percent of ACO executives said they will miss out on key risk-based contract opportunities without a strong financial solutions vendor providing value-based reimbursement software, outsourced services and support and consulting.

_{This article originally appeared in Healthcare Finance News.}