Skip to main content

Success Strategies for Managing Risk-Based Contracts

News  |  By Scott Mace  
   August 23, 2017

Only 23% of net patient revenue comes from value-based payments. In three years, that that is expected to more than double to 48%. Managing financial risk is a must for healthcare organizations.

With the shift from fee-for-service to value-based payment on the upswing, most finance leaders in the healthcare provider industry are focused on adopting and operating risk-based reimbursement models for medical services. Providers must master essential competencies: assessing risk in patient populations and risk-based payment models, and controlling clinical risk through patient engagement strategies.

A May 2017 HealthLeaders Intelligence Report on Value-Based Readiness surveyed more than 150 providers on their current mix of fee-for-service and value-based payment methods. Currently, 74% of those providers are dependent on fee-for-service payment, while the remaining 26% depend on value-based payment. In three years, providers say that mix will change to 48% fee-for-service and 52% value-based payment.

The same survey found that 77% of net patient revenue in those provider organizations currently come from fee-for-service, with the remaining 23% being derived from value-based payment. In three years, those sources are expected to change to 52% and 48% respectively.

In a new HealthLeaders Roundtable Report, Success Strategies for Managing Risk-Based Contracts, learn about these strategies and how you might apply them to your own organizations.

FREE Report Download: Managing Risk-Based Contracts

Here are a few vital questions this report explores:

  • Do your physicians feel like stakeholders during this transition?

  • Are your ACO risk-sharing arrangements less predictable than arrangements made with commercial insurers?

  • Why did many pioneer ACOs fall by the wayside, and what lessons do they hold for your organization?

  • Are you using the correct mix of licensed and non-licensed case managers to most efficiently manage populations under risk-based contracts?

Patients face various risks, and this report describes some of the surprising ways these can impact the success or failure of an organization’s risk-based contract. Participants discuss the importance of risk stratification, allowing them to apply more resources to high-risk patients identified through the risk stratification process.

The panelists describe how data analytics play an important role, but require that organizations go well beyond merely merging claims data with EHR data. Learn how other, non-traditional data can provide the additional insight that could make the difference between success and failure.

Another hot topic: Medicare Advantage, in part because it has several elements in common with Medicare’s new reimbursement system for clinicians under MACRA. In this report, learn about the keys to success in Medicare Advantage contracting.

One element, important to any risk arrangement or global payment contract, is tight specialty referral, to control high specialty costs.

Finally in this report, learn how high-deductible health plans are impacting risk-based contracts.

Participants in this panel include:

  • Alan Lazaroff MD, co-founder and coding medical director, Physician Health Partners, Denver, CO

  • Louis Levitt MD, vice president and physician, The Centers for Advanced Orthopaedics, Bethesda, MD

  • Rick Lopez MD, senior vice president of population health, Atrius Health, Newton, MA

  • Kerri Schroeder, senior vice president and credit products executive, Bank of America Merrill Lynch, Seattle, WA

  • Christopher Cheney (moderator), senior finance editor, HealthLeaders Media

Download the free report today to learn more.

Scott Mace is a contributing writer for HealthLeaders.

Get the latest on healthcare leadership in your inbox.