The current landscape of value-based programs can be summarized in two words: growth and complexity.
More contracts are being created across the country in efforts to meet large goals to have 100% of Medicare and 50% of Medicaid and Commercial reimbursements tied to value-based care contracts by 2025.
Yet as value-based contracts continue to rise, so do some questions regarding how to best manage them, engage contract partners, and produce better outcomes. The following discussion with LaVonna Bowman, Director of Product Innovation at Inovalon, covers some of the top questions in the industry around managing value-based care.
How can both payers and providers know if their programs are actually improving member outcomes?
As Bowman says, “the best way to see if you’re achieving desired member outcomes is to clearly define value-based care contract goals and track every engagement effort toward meeting those goals.” A spreadsheet won’t cut it. Effective contract management requires technology and transparency.
Health plans and their physician partners need technology to set and manage each goal in their contract – and for health plans, each contract in their network. Contract management should include defined quality measures of focus, activities involved in improving measure outcomes, and alerts to know when goals are at risk of not being met.
The right technology can create the transparency health plans and physicians need.
When it’s easy to identify care gaps and understand the member outreach needed to improve performance, there’s less confusion on both sides. Health plans are able to give physicians the information they need to better deliver patient care, and patients receive the focused, quality care they need to achieve better health outcomes.
What are some strategies to effectively manage provider performance?
Data is the key to effectively managing provider performance. Health plans need access to large amounts of data and the ability to easily standardize and make sense of that data. When done well, this can deliver deep insights that may make the difference between contracts meeting or missing their desired outcomes.
“Cloud-based software solutions that support real-time data exchange are driving better contract management across health plans and physician networks. This software also contributes to greater resource utilization as various management strategies are replaced by a single solution to oversee and improve all contracts across networks and member populations”, explains Bowman.
How can health plans better engage network physicians in value-based programs?
While technology, transparency, and deep data insights are highly valuable in driving value-based contract performance, they mean nothing if physicians aren’t engaged in their programs. Value-based care adoption varies widely across provider teams and engagement must be a key focus for health plans.
For physicians, one of the most common barriers in value-based care is lack of time to manage member outreach or report care activities. When empowered with technology that can simplify data collection and reporting, time is no longer an issue. Instead, real-time data exchange informs the actions members need most.
It takes the right combination of health plan and physician talent, technology, and transparency to achieve value-based contract success. Contracts require all three to truly impact member outcomes across networks, and to do so in an efficient, sustainable manner.
With Inovalon ValueCompass™ health plans and physicians gain the insights they need in a secure, sophisticated contract management solution to better track toward program goals. Data is available at the payer and provider level and can be drilled into for more targeted member insights.
For health plans, contract management is simplified and streamlined. For providers, timely information regarding their patient populations and the actions needed to improve quality, reduce costs, and manage revenue is all available in one place, all within their current workflow.
LaVonna Bowman, Director, Product Innovation at Inovalon is a registered nurse with four decades of healthcare experience.