Value-Based Care Consulting for Health Plans
Value-Based Care Consulting for Health Plans
The adoption of value-based care (VBC) consulting for health plans can create transformational impacts, but require significant changes to provider relationship models, care delivery and payment models, increased collaboration among internal divisions and new capabilities across people, process and technology. Baker Tilly can help your organization navigate the complexities of value-based care model adoption and scale to achieve improved health outcomes, quality of care and cost-efficiency.
Advantages of adopting value-based care programs
Improve quality of care
The prioritization of value-based care programs incentivizes healthcare providers to focus on member outcomes rather than the volume of services rendered. These programs can emphasize preventive care, increasingly coordinated treatment and chronic disease management, ultimately leading to care delivered improving member health outcomes.
Align provider incentives
Value-based care programs shift provider financial incentives away from volume of services delivered to those that emphasize rewards for high-quality and cost-efficient care to members.
Enhance provider relationships
Fostering increased collaboration and communication with healthcare providers is crucial to the success of value-based care programs. Many electronic health record (EHR) platforms platforms have features such as Epic Payer Platform, Healthy Planet, Compass Rose, Cheers and others, that enable better data integration and timely data exchange between payers and providers, allowing health plans to streamline information sharing, manage risks and take a more coordinated approach to care delivery.
Maximize cost efficiency
When value-based care programs focus on appropriate care delivery in the optimal setting with emphasis on preventative care or chronic disease management, health plans can improve member care outcomes while maximizing cost efficiency by reducing the need for expensive emergency interventions and hospital readmissions.
Improve data-driven decision making
Value-based care relies on robust data analytics to measure outcomes and performance metrics. By leveraging EHR systems, health insurers can strategically improve data management, identify high-performing providers or areas for improvement and ensure that providers have the right information in hand when they’re caring for their patients to ultimately facilitate better care coordination and care delivery to enhance patient outcomes.
Drive innovation
Incentivizing the adoption of new technologies and care models that improve member outcomes can encourage providers to implement advanced data analytics, telehealth and personalized treatment plans, developing continuous improvement and creativity in healthcare delivery.
Key elements of a successful value-based care programs to drive continued payment transformation
Starting with current state feasibility assessments, we work side by side with you to design and enable end-to-end future state VBC program transformations, complete with program monitoring structures necessary to scale program success.
Feasibility
VBC program initiation requires defining program objectives and an evaluation of whether they are feasible for your organization and all partnering organizations. Determining objective feasibility often requires assessments of proposed financial and care delivery models along with your organization’s current state operational and technical capabilities, external stakeholders, and marketplace factors.
Design
VBC program design must focus on the critical success factors necessary to support a sustainable health plan and provider relationship. This includes transparency, aligned financial incentives, financial and strategic sustainability, and commitment to quality and member/patient satisfaction. From a health plan perspective, it is critical that program capabilities are designed to meet the specific requirements to operationalize the program but with the flexibility to expand to future programs.
Enablement
VBC programs require new operational capabilities, including new systems and processes and extensions to existing foundational fee-for-service capabilities. Enabling the new collaboration among divisions, people, provider relationship models, and new technological and operational capabilities is vital for a program's success.
Monitoring
Post launch, VBC programs require continuous monitoring and optimization efforts to ensure strategic objectives are met and performance does not atrophy over time
Guiding insights
Interoperability FAQ for health plan leaders
Download our complimentary whitepaper for answers to commonly asked questions that leaders of health plans have about the Interoperability and Patient Access final rule.
Interoperability Q&A session for health plans
Listen to our on-demand presentation for health plan leaders about frequently asked questions (FAQs) regarding the Interoperability and Patient Access final rule.
Industry goals for healthcare payment transformation
Discover how healthcare payment transformation is evolving, the challenges of shifting from FFS to VBC and LAN’s goals for two-sided risk models
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