Come to Expect the Best

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Value-Based Reimbursement

Penetration of Value and Risk-Based payment models continue to accelerate in the healthcare market, creating the need to simultaneously manage the requirements, and optimize performance across multiple rapidly changing payment models.

Nirvana Health Group helps providers manage and optimize this transformation through our comprehensive operating partner model. We provide the infrastructure and capabilities required for success and alleviate the growing administrative burdens on providers. This includes the provision of staffing and management resources; standardized and scaled Shared Services operations; and clinically integrated technology for managing populations, networks and contracting.

Nirvana Health Group's point of view on managed risk

Payment model incentives provide logical building blocks and roadmap to take on risk

Payment mechanisms vary; however, the core objectives and operational capability requirements are consistent

Significant financial opportunity exists in today’s market and will continue to grow over time

Revenue cycle operations must transform in scope, scale, and skill sets in order to meet the requirements of the new models

Transitioning to value-based reimbursement will

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Drive significant financial upside

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Alleviate provider administrative burdens

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Create funding mechanisms for future investments

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Prepare for success under risk-contracts

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Create a differentiated value proposition

Nirvana Health Group provides the infrastructure and operational support to deliver disciplined processes, world-class capabilities, and clarity around value-based reimbursement

Resourcing & Management

Dedicated operational resources work directly with your teams to manage and drive value-based care initiatives

1.Management Team(s)

2.Practice Support

3.Educators

4.Trainers & Analysts

Care Management

Applications and support services provide scaled Ambulatory Care Management capabilities

1.Integrated Technology

2.Work-flow Management

3.Staffing Resources

Risk-Based/QMI Coding

Technology and Staffing deliver scaled coding support operations

1.Risk Scores (RAF/HCC) Coding

2.Ambulatory Quality Measures

3.Hospital Acquired Condition

4.Mortality & Severity

Patient Engagement

Tools and patient-centric personnel enable patient management and partnership focused on improved outcomes

1.Care Path Outreach & Facilitation

2.Scheduling & Referral Management

3.Financial Clearance & Pre-registration

4.Customer Service

Patient Financial Advocacy

1.Analytics, workflow and support services facilitate efficient and compassionate patient financial advocacy

2.Dual Eligibility Outreach & Follow-up

3.Bad Debt Prevention

4.Charity

Analytics & Reconciliation

Technology and dedicated teams to reconcile data impacting payer reimbursement and contracted stakeholders

1.Quality Measures & Risk Scoring

2.Attribution

3.Patient Claims Data

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