How Health Plans can Take Value-Based Payment from Contract to Practice in 5 Steps

By Chris Bethell
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We’ve all had great ideas on paper. But for our endeavors to come to fruition, they need to be successfully implemented. The same holds true for payers implementing value-based contracts with their provider networks. It can be enticing to jump in, but the desired outcomes will be the result of well-developed, well-executed contracting plans and processes. Without the right pieces in place, you may find yourself sinking.


Here are five steps to realizing the benefits of value-based contracts with your providers:

 

  1. Create mutually beneficial contracts

    You have the historical data. Payers are able to see utilization, cost, and quality history. Based on this, you have the tools at your finger tips to craft mutually beneficial contracts that put both you and your providers on the same path to success.

    When developing any contract, you want to be clear your goal is for it to be mutually beneficial. Tensions that came to a head in the 1990’s can still be felt today, and it’s up to the payer to have an outstretched hand and a willingness to collaborate.

    Your contract needs to be relevant to your provider groups. Some smaller groups may lack EMR maturity. These providers most likely will need different types of contracts than larger provider groups with sophisticated and mature EMR processes.

    When contracting, you also want to be aware of behavioral health and social determinants of health. The success of a contract, particularly in Medicare and Medicaid, may rely on an expanded network, with certain behavioral, social, and environmental factors that affect care.



  2. Empower Your Providers

    You want to empower your provider base with actionable analytics in regards to quality, cost, and utilization. Larger groups may have the capability in-house, but smaller groups will probably need assistance.

    Identify and pick measures which are important to both you and your network. Then arm your providers by outlining for them specific care and data gaps so that they can intervene. These insights can be delivered in a number of ways: through your provider portal, through their EMR, or through care management systems. Together these produce better outcomes.


Check out the SpectraMedix Value-Based Performance Portal to learn more about how we deliver actionable insights to your provider network

  1. Align Your Network

    Alignment across the entire care team is essential for success in value-based payment. Everyone involved in the patient health journey has a unique role but operates in a chorus to achieve unified goals—healthier patients, better outcomes, lower costs, and higher quality care.

    Providers as well as social workers, community-based organizations, and other stakeholders all need patient level data with role-defined access to that information to make an impact. Without alignment, treatment and accountability can slip through the cracks, leading to poorer outcomes and higher costs.


  2. Discover & Learn

    Healthcare is far from simple. Curveballs are to be expected, and you need to prepare for these with self-service analytics. Your provider group may ask for information that isn’t readily available in monthly reports, you may have a provider group without analytics capabilities, or you may take on a new employer client that doesn’t fit into your current framework. On demand advanced analytics allow you to constantly learn and also provide opportunities to discover new ways to drill-down and act on newly discovered information.

  3. Expand Predictive Modeling

    Predictive modeling helps you forecast outcomes and allows your providers to pivot their care delivery to meet contract benchmarks by end-of-term. They can also be utilized to identify high-cost, high-risk and rising-risk patients, including those at-risk high-risk for unnecessary admission and readmission.

 

With mutually beneficial contracts, empowered providers, care team alignment, constant discovery, and predictive modelling you won’t be sinking or even floating—you’ll be swimming.

Tags: Value Based Payments, Health Plans

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