Risky business for providers: Five key actions to establish medical risk-bearing

Value-based models are becoming a normal part of the health care provider landscape. Several accountable care organizations (ACOs) are already taking on higher levels of patient medical risk, which means there are financial stakes in improving health and quality across the populations they serve.

Taking on risk is a complicated endeavor for most providers, but there are five key actions that several leading institutions are using for success.

Before starting, it’s important to remember that the foundation of a favorable outcome relies on alignment and consensus-building among all parties affected by these changes. This requires consistent, ongoing communication and regular involvement from physicians, leadership, and patients alike.

So, let’s get started. Here are overviews of the five action points that lead to risk-bearing success. In future blog posts, we’ll discuss each of Miles Snowden, MD, MPH, CEBS Chief Medical Officer, OptumHealththese items and organizations that have leveraged them.

Market Assessment

You can’t know which way to go without first understanding how the current market landscape may alter your moves to value-based models. Take the time to understand how health care dollars flow across your local marketplace, who are the payers and products in the markets, and how your local market actually influences payers and products. For example, demographic and reform trends could impact payers and patient populations.

Strategic Structure

Next up is determining the appropriate structure and governance model for your organization. Will you choose to become an ACO, a clinically integrated network (CIN), or a physician/hospital organization (PHO)? Vision, governance, guiding principles, and operating models all must be clearly defined, followed by the network structure for physicians and incentive models to ensure alignment.

Population-Based Planning

The third action is seeing if bearing risk pays off for each population-based opportunity. This takes analyzing data to find opportunities to partner with payers that reach populations where improvements can be made. And eyes need to be on the future to define population value-based care models and perform population-based gap analyses and resource needs.

Financial and Capacity Planning

Does your current financial model support investment in a risk-bearing model and ensure you’ll meet monetary goals? Good financial and capacity planning requires defining inpatient and outpatient optimization opportunities based on operational benchmarks, while also outlining risk. This ties back to understanding how market forces and populations impact utilization and capacity.

Value-Transformation Road map

Once you have the four other actions in hand, it’s time to plot a course to take your organization from planning to practice. Top-of-mind for any risk-bearing provider organization is costs that impact care. You’ll need to chart population-based and care model paths and identify opportunities to direct care to lower cost settings. This is the time to sequence movement into value-based models for payers and populations, while creating a coordinated value-transformation roadmap across capabilities.

Over the next few weeks, you’ll find more detailed information about each waypoint and how to put them together. If you want to get the full story now, please download the white paper: The Next Stage of Value Transformation.


Miles Snowden, MD

4 thoughts on “Risky business for providers: Five key actions to establish medical risk-bearing

  1. Pingback: Risky business for providers: Building value-based and market-based models | Healthcare Exchange

  2. Pingback: Risky business for providers: Strong leaders, appropriate structure needed | Healthcare Exchange

  3. Pingback: Risky business for providers: Population-based planning in provider risk-bearing arrangements | Healthcare Exchange

  4. Pingback: Risky business for providers: Planning for financial realities and capacity downturns | Healthcare Exchange

Leave a Reply