Are your payor contracts aligned with your ambulatory strategy?

It has been said that you can’t have an ambulatory strategy without a reimbursement strategy. But what if we told you that your reimbursement strategy should lead your ambulatory strategy, especially in the beginning?

If you have been following LeftCoast Healthcare Advisors for a while, you have likely heard us emphasize the importance of involving key stakeholders early in the process and developing strategies that are Physician First in nature. However, without understanding how your services are currently reimbursed based on their location, how can you determine what can and cannot be migrated to a new location in the future? Do your reimbursement strategies account for planned changes to the location of services? Will you be paid appropriately in this new setting? Does your staff have the necessary training to capture a new type of reimbursement? These are all critical components of a larger puzzle that must be addressed before the first case migrates. ?

When considering the ambulatory strategy journey, it's important to recognize that while each stakeholder plays a role, their involvement isn’t necessarily linear. Successful ambulatory strategies involve key stakeholders' input early in the process and then focus on revising and refining tactics as the plans progress. From a payor contracting standpoint, their initial role may seem to restrict growth by only recommending areas that can be adequately reimbursed. But over time, the payor contracting team plays a key strategic role, helping to lead the organization by developing reimbursement models that drive growth and expansion by making unprofitable cases today profitable in the future.

This type of collaboration doesn’t happen in a single meeting or planning session. Developing a successful ambulatory reimbursement strategy takes time. Why? Because reengineering payment systems takes time, sometimes years, with multiple rounds of contract negotiations and significant data support, to fully operationalize the value. By involving your payor contracting teams early in your strategic planning process, you can help them prepare to proactively negotiate based on the organization's future plans.

Successful ambulatory programs migrate the right cases at the right time by understanding and leveraging the most appropriate financial and operational factors to drive the best possible physician and patient outcomes for a given community. When the right teams are involved, the process moves faster, creating an environment that not only meets but exceeds the organization's goals and community needs.

Join us next week for part 6 of our hospital ambulatory strategy series focused on key considerations for successful case migration!