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.
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.
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.