Navigating your alternative payment model journey: implementing, scaling and evolving your program

David Mauzey, General Manager, Optum Payment Innovation, was a guest speaker at the Scottsdale Institute on September 26. He shared how bundled payments can help accomplish business strategies. Part II of this two-part blog concludes with suggested best practices to consider when implementing, maintaining, scaling and evolving your alternative payment model.

Implementing your program
Here is where “the rubber meets the road”. Using information from your initial strategy and rollout plan strategy is what you’ll use to put the program into production. It will help the actual implementation of your alternative payment model program become fairly straightforward.

Expand your horizons
As mentioned in Part I, a gradual transition to risk allows you to move from an activity-based model to a more engaged, coordinated and high-performing health care organization:

  • Expand product offerings – leverage automation.
  • Drive program efficiency with advanced analytics, operations and more population health areas.

Focus on the whole patient outcome
Patients and providers view outcomes differently:

  • Providers view from a clinical standpoint for success. For example, post-surgical x-rays show the knee healed correctly.
  • Patients see it from the perspective of have they been able to return to the quality of life they had before the health care event? Engage, partner and educate patients through every step of the process to work with clinical partners, gain commitment and help modify risk.

Measure success, evaluate opportunities
Changing value and performance metrics make it difficult for health care organizations to evaluate and report on the alternative payment model programs in which they participate. Each player you partner with in a value-based or bundled payment program has its own goals and standards for the types and timing of the data it needs to track performance.

Three key considerations
Value is created when care is redesigned. It takes a village to implement an APM program — from multi-disciplinary teams (clinical, revenue, technology, etc.) to physician champions to care coordinators. Here are three key considerations to keep in mind:

  1. Employ the right technology and advancements – these two elements are keys to bringing efficiencies to the actual operationalization of a program. Is the program flexible to integrate into your current systems?
  2. Grow, maintain and scale your program over the long term – Maintaining a successful alternative payment model program requires continual evolution and improvement. Understanding how current alternative payment model programs are performing and how the overall program is performing, gives insight into the next steps for improving your program.
  3. Measure and evaluate all outcomes – from financial savings through patient experience to help achieve positive clinical and operational outcomes. Understand and analyze the data to help you plan future steps through reporting:
    • Financial
    • Analytical
    • Operational
    • Performance
    • Clinical data
    • Claims data

Moving from strategy to results requires strong execution
Work with a data management partner that can support your move from volume to value right from the start — building, scaling and administering alternative payment models of all types – including expertise at defining, implementing, operating, reporting and evolving VBC and bundle payment programs.

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With the right technology expert in your corner, you can evolve payment programs efficiently without adding infrastructure and with the right administrative tools and performance insights.

Want to know more?

  • Register for webinar part 2 on November 8th

About the author:

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David Mauzey
General Manager, Optum Payment Innovation

David leads the development of financial administration platforms used to execute value-based contracting programs. Prior to joining Optum, David spent 17 years working with an enterprise network administration and claim pricing organization. Serving as both Chief Operating Officer and Chief Information Officer, David gained a great appreciation for finding the right operational and technical balance that align to organizations’ visions. Today, David focuses on enabling organizations to better deploy their payment innovation strategies.

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