The Case for Our Transformational Perspective

Healthcare organizations stand at a tipping point where the strategy and tactics they employ today will profoundly impact their opportunity for success in the years to come. The foundation of that tipping point is the increasing payer focus on the higher-quality / lower-cost dynamic. This has resulted in an environment that is moving with building urgency toward greater clinical integration and population management.

As the evolution continues, purchasers will place more pricing pressure on the industry, and risk based contracts will become the norm. This step change will present the prepared provider with opportunities for margin retention / enhancement. These opportunities will be balanced by an increase to an organization’s business model risk.

Therefore to thrive in this environment, healthcare providers must be prepared to accept greater risk for payment of services with greater insight into the impact that risk presents the organization both financially and operationally. This is the essence of Risk Capability. Increasing an organization’s Risk Capability requires a focus on three critical success factors: Enterprise Intelligence, Revenue Transformation and Clinical Enterprise Maturity.

Three Critical Success Factors for Risk Capability:

1. Enterprise Intelligence 

  • Define the populations they serve
  • Understand utilization trends and related costs by service categories
  • Create more elegant and sophisticated forecasts
  • Stress test historic and evolving assumptions
  • Build ways to monitor expectations and results

2. Revenue Transformation

  • Understand reimbursement across multiple revenue models
  • Proactively identify and address process improvement opportunities
  • Monitor and rapidly address revenue leakage
  • Utilize forward looking data elements to make go forward decisions
  • Quickly adapt and actively manage new revenue models

3. Clinical Enterprise Maturity 

  • Organize, build and operate an integrated clinical enterprise
  • Build multi-disciplinary teams that cross historic boundaries 
  • Improve outcomes and manage costs within the populations they serve
  • Thoughtfully accept outcomes-based risk and compensation

Key Contacts:

Brad Benton | Managing Partner | Brad.Benton@dhgllp.com | 404.681.8228

Kevin Locke | Principal | Kevin.Locke@dhgllp.com | 615.454.9735

Trent Messick | Partner | Trent.Messick@dhgllp.com | 336.714.8138

Scott Spohn | Partner | Scott.Spohn@dhgllp.com | 404.575.8993

Edward Stall | Principal | Edward.Stall@dhgllp.com | 864.312.5515

Publications Publications
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DHG Healthcare’s New Perspectives for Consideration
The overall implications of achieving Risk Capability as defined by DHG Healthcare, mandate a level of institutional courage that is not easily
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Financial Assistance Regulations For ‘Other’ Provide...
As enacted by the Affordable Care Act of 2010, 501(c)(3) hospitals are now obligated to meet additional requirements to gain and retain 501(c)(3) tax
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Determining Your Organization's 'Risk Capability'
To be successful in a healthcare reform environment, providers must develop key capabilities for managing financial and performance-based risk.
Read More
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