Proactive Management of Value-Based Care

We hear a lot, especially in an election year, about the challenges between stakeholders who inhabit the same professional space and are beholden to the same people but have different focal points from different perspectives. So, the positioning of co-existing parties as combatants is familiar if not compelling.  

But let’s give that storyline a break for a bit. We work with payors and providers, and occasionally we hear griping from one side about the other. But now that payors and providers increasingly share financial risk in alternative payment models, their goals are more closely aligned. Their contracts detail performance measures, and their bank accounts swell and compress based on how close they come to the ideals set out at the start. Simply stated, value-based care is like a Hollywood drama in which sometimes opponents unite against a challenge neither can contemplate losing. 

Here are the commonalities: Both sides want to reduce costs, elevate care quality and improve health outcomes. Value-based contracts not only aim to achieve these goals, but in the effort, may advance health equity and more stable, supportive communities. Keeping an eye on those contracts is paramount. 

However, the tally of Centers for Medicare & Medicaid Services as well as commercial arrangements that ditch fee for service in lieu of risk pools, per member per month capitated payments and other fiscally smart trends are always rising. How can you keep on top of all your value-based contracts and other innovative payment arrangements? 

Refer to this “Proactive Management of Value-Based Care” checklist.  

Gray Matter’s CoreTechs® Analytics solution features a Contract Insights module — a single location to view all contracts. Providers see all contracts across their payor partnerships, and payors see contracts with all provider groups or health systems. A quick glance can elicit a sigh of relief if everything is on track to meet or exceed performance thresholds. Or it can highlight underperformance … and functionality to get to the root cause of gaps in care or low adherence to measures.