Value-based contracts are the future in healthcare. This is true for all lines of business—including commercial, Medicare, Medicare Advantage, and Medicaid. While payers have typically driven value-based contract adoption, providers are warming up to the concept.
How can payers help accelerate the shift to value-based contracts by their providers? Here are four ways to create tighter payer/provider alignment and a foundation for mutually beneficial relationships that lower costs, improve quality, and produce better outcomes.
1. Eliminate the FUD Factor
Providers entering risk-based contracts are filled with fear, uncertainty, and doubt (FUD). They fear they will lose money, are uncertain of the parameters of the relationship, and doubtful that payers have their best interests in mind. According Roy Beveridge, MD, CMO of Humana, “Now, as providers shift away from the fee-for-service model, the key to eliminating that disharmony lies in developing a strong sense of trust.”
Much of that trust begins with building transparency into the contracting process. Payers want to create contracts that meet financial targets, but they need to show providers how they can thrive in arrangements within the payer’s member population. Transparency in contract terms, variables, and parameters, is critical to building provider trust. The more you can automate this process and model different value-based contracts, the better off you and your providers will be during the contracting process.
2. Understand the Other 80% of Care
Up to 80% of factors relating to health fall outside traditional clinical care. Items such as health behaviors, physical environment, socioeconomic factors, and behavioral health all impact patient outcomes. These factors fall under the umbrella of Social Determinants of Health (SDoH), which are critical to the value-based contracting process. While the technology to collect this data continues to improve, it often reaches providers too late to enact meaningful impact.
During the transition to value-based care and value-based contracts, it’s imperative that providers have the analytics needed to respond faster to patient needs. One of the best ways to do this is to ensure you have a software platform that integrates these disparate data sources, making the right data available so interventions in care are completed in a timely manner.
3. Keep the Ball in the Provider’s Court
It’s important to always keep in mind that providers are constantly busy and that their time is a precious resource. The time taken on their part to learn and embrace new technologies is time that could be spent providing and administering care.
Make sure your analytics and contract modeling systems are suited to their workflow—whether it’s your high adoption portal, electronic health records (EHRs), or any other workflow system. Give them the actionable insights they need when needed so they can direct the best, most efficient course of action in their patient care.
4. Reduce the Friction Between Providers and Payers
Transparency is key to mutual payer/provider success in value-based contracts. Decades of distrust in the fee-for-service model has put providers and payers at odds. Both parties need to partner together to improve all aspects of value-based care—including quality, utilization, and cost. If your current systems don’t support you and your providers from precontracting through reconciliation at the end of the contract term, it’s imperative to future success that you review those systems so you and your providers are all flowing in the same direction and working with the same set of information.
This blog post is an abbreviated version of our SpectraMedix eBook, “Four Ways to Accelerate Value-Based Payment Contract Adoption by Your Providers”. To get the entire picture, including a bonus fifth way to better enable providers top adopt value-based contracts, you can download the full eBook.