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 that looked good on paper. But for our endeavors to truly come to fruition, they need to be successful in practice. It can be enticing to just jump into the pool of value-based payment contracting, but the best outcomes start with fully thought out contracting processes which lead to success at achieving the quadruple aim at contract’s end. Without the right mindset and tools, you may find yourself sinking.

 

  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 path to success.

    When crafting any contract, you want to be genuine and forward that it is mutually beneficial. Tensions that came to a head in the 1990’s can still be felt today, and it’s up to you 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, in which case some type of contracts may not be feasible compared to 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, as certain behavioral, social, and environmental factors may 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.

    You want to identify and pick measures which are most important to you and that have the highest opportunity for a return on investment. You then arm your providers by outlining specific gaps and interventions and delivering them in a number of ways: on 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. Curve balls 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 allows you to constantly learn and also provides an opportunity to discover new ways to drill down data and act on your analytics.

  3. Expand Predictive Modeling

    Predictive modeling helps you forecast outcomes in real time, and allows your providers to pivot their care delivery to meet contract benchmarks by end-of-contract based on where they currently stand. It can also be utilized to identify high-cost and high-risk patients, as well as high-risk patients for admissions and readmission and rising risk.

 

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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