Value Based Care Tools for SuccessBy: Monte Regier, MS

After 10 years of watching health systems work to meet the increasing requirements of Shared Savings and Value Based Contracts, for many providers success is elusive. Here are some reasons why.

The emotional shift from fee-for-service to value-based care puts significant pressure on physicians to make changes to well established processes and workflows. Many Value Based Care Contracts are signed without a clear assessment of training and resources that will be needed to make the transition. It is not uncommon for a contract to be executed with six months past, and leadership is still asking how the contract works or why the contract is not performing, with little training or changes to processes implemented. Without training and process changes, supported by accurate data and analytics, it is unlikely that a Value Based Contract will produce positive ROI’s.

Successful transitions from fee for service contracts to team driven Value Based Care mostly comes down to ownership and responsibility. When a contracting team is negotiating terms, they have insights into what will be required to reach success. During the negotiation process business and clinical process maps need to be created which clearly identifies each contract success variable. This map should define specific department objectives, staff training required, persons held accountable for driving change to meet goals, and ongoing data that will be needed to measure progress. Before the contract is signed all stakeholders need to produce their plan for success.

High performing health systems manage Value Based Contracts inside of P&L operating structures. This typically solves accountability problems as contract performance is financially tied to the success of the contracts team. Health plans do not care for these structures because contracts with a low probability for success or low ROI typically get little attention. For health systems this is good because not spending time on contract activities that produce little value to the organization eliminates the drain on valuable resources.

As the healthcare market matures toward payer / provider relationships that share financial risk the importance of contract ownership, accountability, and accurate real time data to drive results will increase. It will not be wise to simply roll the dice and hope that a contract will be successful, when at risk dollars will be taken back. CMS has been moving Medicare plans and providers in this direction for several years and will speed up the process with Direct Contracting starting in 2021. This will prompt health plans to introduce new contract terms to a larger pool of providers adding partial risk to Value Based Care contracts.

Decisive Data helps providers organize data for success. We understand the business and clinical processes that build success. For more information or to start a health analytics project reach out today.

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