Health plans are facing significant, systemic changes as they move away from strictly fee-for-service payment arrangements and toward quality-focused, risk-based payment models. While health plans recognize that their existing financial and operational models must look different to accommodate these changes, they may be struggling with how to design and implement a risk-based reimbursement strategy.
In determining how to implement value-based reimbursement (VBR), consider a phased-in approach, focusing on one population and analyzing those results before scaling up the program. Here are three factors to consider as you plan your VBR strategy:
- Determine how specific capabilities affect your plan’s infrastructure. How does the model impact Finance? Contracting? Will call centers receive an increase in calls? Plans should coordinate across all functional areas and take a team approach.
- Connect with IT and analytics to determine how to measure shared risk. Is your data reliable and valid? How will you collect and use your claims, as well as your clinical and care management data?
- Think about provider buy-in and how you can work together with providers. Be transparent with your providers. They must be able to understand the data that affects their compensation.
Learn more about risk-based payment implementation and other trends impacting health plans today at http://www.optum.com/ontrend
About the Author:
Melissa Barrett, R.N, M.A. Senior Consultant
Melissa Barrett holds over 20 years of healthcare experience in various healthcare roles. She is a Registered Nurse.
Her experience spans a wide variety of perspectives including clinical experience in hospitals and home care, health plan operations, vendor management and oversight, compliance, auditing, care and case management, disease management, operational quality improvement, program management for Medicare Advantage and Prescription Drug programs and project management.