Value-based payment (VBP) programs are the future of healthcare. However, implementing a successful VBP program that improves outcomes while controlling costs for both payers and their provider networks requires careful planning. What factors need to be front of mind?
Let’s explore five critical components that health plans need to consider when designing and supporting a successful VBP program.
1) Data Ingestion and Transformation:
One of the fundamental components of a VBP program is the ability to ingest and transform data from various sources into usable information. This process can be complex, considering the lack of standardized formats and unique challenges posed by each client (such as data residing across multiple systems and modules). Health plans must have in place robust data integration capabilities that enable them to pull the insights they need to improve performance and identify areas where help is needed.
2) Contract Modeling:
Contract modeling plays a crucial role in negotiating contracts. Health plans need tools that enable them to model and share with their providers, in advance, the terms of a contract based on their own data. This help to facilitate better negotiations, provide a better understanding of the financial impact of terms, and to paint a picture of what the financial reconciliation might look like. This approach allows for transparency along with risk assessment and adjustments, ensuring achievable goals and effective contract management.
3) Budget Setting:
Setting a budget is essential for VBP program success. To effectively measure progress and achieve VBP program goals, health plans must calculate budgets and targets annually while considering risk factors, trend analysis, and other relevant variables. This flexibility enables accurate budgeting, proactive decision-making, and effective cost management for continuous improvement and adjustment, as well as ensuring the program stays aligned with its objectives.
4) VBP and Self-Service Analytics:
VBP program implementation and management requires comprehensive analytics to identify cost drivers and quality and utilization areas that need improvement. Ideally, this includes self-service analytics tools that empower both health plans and providers to go beyond fixed reports and run customized reports tailored to their unique needs. Moreover, self-service analytics empower health plans to explore their data and gain deeper insights when making data-driven decisions.
5) Strategic Analysis:
To maximize the effectiveness of a VBP program, health plans should not only provide reports, but also offer strategic analysis and insights. By reviewing program reports and identifying patterns, payers can provide recommendations and deliver a support system to their providers. This collaborative approach helps health plans and providers to develop strategies for improving performance, optimizing outcomes, and achieving long-term success.
Conclusion:
Embracing innovation and prioritizing VBP program development will position your organization for a brighter and more sustainable future in healthcare. By incorporating data ingestion and transformation, contract modeling, budget setting, results analytics, and deeper strategic analysis, payers will be positioned to gain valuable insights, make informed decisions, and succeed in the continually changing VBP healthcare landscape.
Interested in learning more about this topic, check out our On-Demand Webinar, “A Payer Perspective on Optimizing Provider Enablement in the Value-Based World”.
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