As you see health care transitioning away from traditional fee-for-service payments and toward performance-based payments, value-based reimbursement (VBR) approaches are becoming popular options for health plans. Pay-for-performance contracts, patient-centered medical homes, bundled payments and accountable care organizations offer unique value creation while allowing payer organizations to work collaboratively with their provider partners.
Payers are looking to improve clinical performance and provider relationships. At the same time, providers are looking to gain more risk-based business to reduce overall costs, and monitor performance and quality as it relates to their ability to deliver services.
To perform as needed, value-based models require technological and administrative ingenuity to support and empower risk-based strategies across provider, payer and consumer spectrums. Through broader analytics infrastructure and integration of quality measures, health plans can:
- Reduce medical costs while maintaining care quality and performance improvement measures
- Reduce network operating cost while improving efficiency
- Support connected, intelligent and aligned communities
Plans can start by leveraging network analytics within value-based contracts for insight into business decisions influencing provider transparency and overall contractual performance.
Aligning value-based contracting and incentive models to overall financial impact or return on investment is also critical. However, it’s important to realize that while some models may bend medical cost curve trends better than others, the payer may actually have less control if the model is dependent on collaboration or provider-managed risk.
Roster management, attribution and provider network measurement align quality and business metrics. The last of these — provider network measurement — uses population measures and other metrics to determine which providers are delivering high-quality care at the lowest cost. As a result, plans can confirm that the contractual commitments they are trying to drive will be served and will, in effect, bring down the cost of care.
Finally, member engagement plays an important role in VBR success. Consumer support tools, educational programs and resources, and alternative care options can help members find the right care, at the right time and at the right cost.
To read more about value-based reimbursement, download our article “Value-based reimbursement models call for innovative payment administration.”
–by Mark Anderson, VP, Clinical Solutions & Technology, Optum
Anderson leads the innovation effort around value-based reimbursement administration and advanced analytics. He holds more than 20 years of experience in executive leadership, strategy, M&A, budgeting, product commercialization, and advanced analytics within health and human capital services. Previously, Mark’s been on the advisory boards for many national organizations and the strategic benefits board for leading Fortune 500 corporations. Mark was also the recipient of the renowned “Medistar Award” in 2008.