The Value of Transparency in VBC Contracts

By Chris Bethell

Physicians’ attitudes toward value-based care (VBC) have changed within the last four years. In 2016, the majority of physicians didn’t see value-based care as the future of healthcare. According to a survey of US physicians, “considerably more physician support and participation will be required to achieve the goals of healthcare reform and to transform the healthcare system from one based on volume to one based on value.”

Two years later, a 2018 survey indicated the tides had shifted—47% of physicians had some compensation tied to value. However, more than 50% of physicians disagreed that VBC would improve care and reduce costs.

Successful value-based payment contracts are driven by actionable data that informs both the payer and the provider. Payers need to define clinical expectations, use measures that support those expectations, and deliver feedback to providers for continual improvement. This transparency does two things: it gives providers the insights they need to effectively negotiate, implement, and reconcile contracts and lets them know that the payer is supporting them (something they know has not always been the case).


Enabling Data Transparency

Providers need to feel confident in value-based payment. You want your clinicians to see contracting for VBC in a positive light. This means enabling your providers to make informed healthcare decisions. For provider buy-in and VBC success, transparency is vital.

Retrospective and prospective insight allows your providers to track their performance and course correct. VBC is complex and based on data that providers traditionally don’t have access to. Being able to access historic claims data provides insights that inform care delivery and help improve overall population health and ROI. Meaningful detail allows providers to improve focus. Knowing which measures aren’t being met presents opportunity. Care gaps are easier to address as they become clear and assembled in one place. Understanding expectations upfront helps achieve the triple aim: lower costs, higher quality, greater patient satisfaction, and greater provider satisfaction.

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When Transparency Meets Contract Modeling

Both parties hope at the time of signing that they will receive their return on investment (ROI). Either party might find over the course of the contract though that they are not hitting their targets. A well-balanced contract, developed with contract modeling software, will provide both sides opportunities to make adjustments mid-contract. This means no dropping bombs on providers like changing payment, incentive, or shared percentage. What it does mean is allowing providers to see improvement possibilities so they can pivot their care delivery to meet targets by contract’s end.

By end-of-contract, you’ll be able to compare results to contractual term. With proper data transparency, your providers should be hitting their marks. If not, this is an opportunity to learn how to coordinate and plan for the next contract. And you may even exceed expectations, which presents an opportunity to celebrate—but don’t forget to consider additional areas for improvement and continue doing what works!


Gaining Provider Trust

As the surveys mentioned above show, many providers may still be reluctant to enter in VBC arrangements. You want to foster trust, which means including them as an equal in negotiation to quell any fears or doubts they may be having. VBC is an opportunity to thrive in healthcare, and you need to demonstrate this start to finish with good-faith negotiation and demonstrating the opportunity for them to succeed.

Utilizing transparency is critical in VBC success. From data transparency to gaining provider trust, transparent value-based care contracts lay the groundwork for cost-effective, high-quality care where payer and provider goals are aligned.

Tags: Value Based Payments, Health Plans

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