Value-Based Care Contracting

The Importance of Contracting Dynamics

With several variables informing the value-based care contracting process, organizations negotiating terms with health plans must be armed with the right information.

Groups that struggle to achieve success under value-based payment contracts often lack access to data that is fundamentally important when making a range of decisions - from defining contractual terms to identifying gaps in clinical performance. Developing a business intelligence strategy, therefore, is critical to supporting payer contracting across the provider spectrum.

HealthEC Empowers Organizations in Negotiating Value-Based Contracts

Building a successful value-based care program begins with data analysis, and HealthEC empowers organizations by integrating patient information across providers, systems and settings to define the following:
  • Performance on quality metrics by provider, group and organization, with comparison to local, regional and national benchmarks
  • Total cost of care details by diagnosis, practice and service delivery setting
  • Patient population demographics such as risk scores, chronic illnesses and co-morbid conditions
Equipped with a solid understanding of current clinical and operational performance, organizations are better prepared to discuss the financial and operational considerations associated with value-based care arrangements, including:
  • Unit costing and tracking
  • Risk assessment and planning
  • Physician engagement
  • Transparency and accountability
  • Performance tracking and improvement activities
  • Physician compensation and funds distribution

Experience in Managing High-Risk Patient Populations

One of the most daunting elements of value-based contracting is risk management, where profitability hinges on an organization’s ability to manage care for chronically-ill and fragile patient populations. With experience establishing care coordination programs to address the specific needs of high-risk groups, HealthEC fosters organizational success under value-based programs.

HealthEC helps organizations create a care management plan inclusive of infrastructure requirements, resources and population analysis, as well as articulate the ability to deliver on value-based care program goals. The plan informs contract-related discussions about outcome metrics, cost models and service delivery capabilities.

Achieving Value-Based Care Contracting Goals

Negotiating performance metrics and risk must be based upon a solid understanding of the patient population, provider performance and network resources in order to optimize outcomes for physicians, patients and the health plan. HealthEC’s proven methodologies and market-leading analytics ensure that customers can define their value propositions, encourage physician engagement and create incentive compensation plans aligned with value-based metrics.

Extensive experience in value-based care contracting incorporates key incentive-related considerations such as upfront payments, the role of the EMR, correlating Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) scores, and utilization and cost metrics. Common pitfalls can also be avoided with a knowledgeable approach to capitation, revenue cycle management loopholes for providers, and shared risk pitfalls for defined populations.

HealthEC empowers organizations throughout the value-based care contract discussion process by:
  • Identifying current clinical and operational performance at the organization, group and provider level
  • Defining population risk
  • Supporting contract discussions with data and expertise
  • Developing and executing a care coordination strategy
  • Facilitating physician engagement in the program