The U.S. healthcare industry has evolved drastically to embrace value-based care models. As the journey continues, so too does payer and provider exploration of the most effective ways to manage value-based care contracts.
The Affordable Care Act of 2010 triggered a massive movement to transition the healthcare delivery system away from a model that ties reimbursement solely based on the volume of services provided to the one based on the value of those services as demonstrated by improved outcomes. This shift in the industry has inspired payers and providers to adopt value-based care models to drive better clinical outcomes, deliver patient-centric care, reduce healthcare costs, and improve economics across the healthcare continuum.
The Centers for Medicare & Medicaid Services (CMS) has demonstrated its commitment to advancing value-based care through the introduction of several value-based care models across the healthcare spectrum. In addition to these concerted federal efforts, many states have made progress in moving towards value-based care payments in healthcare.
Recognizing that value-based care programs are the future of healthcare industry, in addition to CMS efforts, the Biden-Harris administration is also reviewing current value-based reimbursement models for ongoing improvement and ways to encourage more health plans to adopt these reimbursement models for their commercial populations.
As the transition to value-based care continues to evolve and providers take on increased risk under these models, there is a need to empower providers with the necessary infrastructure support. In addition to managing value-based contracts, data -driven analysis and reporting adds additional administrative burden for payers. While the construction of effective value-based care contracts can be challenging and time-consuming, ongoing management of these contracts and driving initiatives to meet the overall objectives can be equally challenging.
A streamlined technology strategy is integral for payers and providers to achieve their value-based care goals. This is evident as per the recent polling exercise by Inovalon among health plans and providers at RISE National 2021, where it was reported that:
- 40% find lack of data interoperability challenging in managing value-based care programs
- 32% consider multiple technology platforms from various payers for performance reports a hindrance to value-based care models
- 36% have 5%-25% of their organization’s payments that are currently flowing through value-based care arrangements
- 45% believe 25%-50% of their organization’s claim payments will flow through value-based care arrangements in the next 3 years
For payers, we classify value-based care contract management and reporting requirements into the following buckets:
- Gathering comprehensive datasets (claims data, clinical data, social determinants of health, and other data) to support value-based care analytics and reporting.
- Quickly and effectively analyzing the data and creating reporting to drive transparency for providers without increasing internal administrative burden.
- Effectively engaging providers, sharing performance reports, and enabling providers to act.
- Successfully tracking progress and ultimately driving payment decisions.
For providers, we classify the requirements into the following categories:
- Receiving gaps in care information that is concise and actionable.
- Ensuring that gaps in care information are reported timely without much lag.
- Establishing that gaps in care information are accurate.
- Having access to an integrated platform to receive gaps in care information from multiple payers (thereby replacing a myriad of delivery channels and formats from various payers).
Technology and data-driven analytics play an integral role in supporting payers and providers to succeed under value-based models. Payers and providers require a high-volume, high-velocity analytics platform that brings together data from multiple sources to provide timely and comprehensive insights into patient gaps in care. By implementing advanced technology to collate, curate, and analyze data to present actionable insights, administrative burden can be relieved, and transparency can be enhanced, resulting in measurable impact and success for both payers and providers.
Inovalon ValueCompass™ reduces the complexity of managing value-based contracts by providing a streamlined, cost-effective cloud-based solution that replaces manual value-based contracting processes, which can be error-prone and inefficient. It is a web-based tool that allows for highly flexible, tailored experiences for payers and providers and improves transparency via a simple, user-friendly portal.
Contact us today or schedule a demo and learn more.