How Do You Define the Cost of Care?

Healthcare payers, provider organizations, and especially patients all agree that healthcare costs are at unsustainable levels. One potential solution to this far-reaching problem is the new value-based care payment model.

As the industry moves from fee-for-service to value-based care, the need for cost efficiency is intensifying. As provider organizations take on risk, they need to better understand and manage their total cost of care. And those organizations that aren’t prepared to take steps to manage costs will struggle to survive the transition.

Conversely, if provider organizations can understand and then manage their cost of care while going at risk in government and payer agreements, they stand to make financial gains and help even out the upward trajectory of healthcare costs overall. Everyone wins.

But cost of care is far from defined at the moment. Everybody has a unique plan, but nobody really has the tool kit to execute their plans. There is a lot of strategy but no standard solution.

Out of a desire to clarify the space and help provider organizations know where to turn for support, KLAS has interviewed leadership at provider organizations invested in cost of care. These are organizations that have a strategy for cost of care. They shared their experiences with the tools, consulting firms, and other approaches they are using to support their strategies.

From their input, KLAS will publish a framework showing the top strategies provider organizations are deploying to understand, manage, and reduce cost of care. This will include an outline of organizations’ approaches to cost-of-care management and the tools and resources they are using and/or considering for it. This framework will help organizations create their own road maps to success with cost of care.

In our research, we also discovered three main components that provider organizations need to successfully manage cost of care:

1. Aggregated data from all sources and care settings
2. Software and services to help aggregate data, provide insights, and provide actionable, empowering data that leads to meaningful interventions
3. Processes, expertise, data governance, and leadership buy-in

The upcoming KLAS report on cost of care will go into more detail about how provider organizations can overcome challenges with these components and where to turn for help.

Watch for our next blog post on cost of care, where we’ll share more about the technologies currently available in this space, and how KLAS has begun to lay out a framework to measure their successes.