Value Based Care Agreements

Whether it is a payer, supplier or life sciences company considering a results-based contract, it is important that everyone can assess their current state and that of their counterparts to determine whether a value-based contract offers value as a strategic step. Data analysis is an essential part of a value-based payment agreement that provides providers with a better understanding of their patients, including all interactions they have had with the health care system. In addition, data are used to determine the improvement in performance metrics. Value-based health care is the inevitable future of health care and will rely heavily not only on strategy, but also on the right technology. Small clinics, in particular, need integrated EHR management and practical management software to help their patients and collaborators manage the transition successfully. These clinics should look for software that fosters cooperation, emphasizes analytical reporting and facilitates integration with existing software and third-party hardware. It`s a great place to start. Responsible care organizations are probably the best known value model and are voluntary programs in which physicians and hospitals are paid by health plans to improve outcomes and respond to specific quality metrics (for good reason). They can include payment models, including purchases based on value, shared savings and payment performance.

Providers themselves are „responsible” for managing the health of their registered patients at all levels of care and are entitled to bonuses to slow the growth of spending relative to their peers in a given region. Incomplete data is often a problem. Insurers cannot provide suppliers with all price information due to data protection agreements with other supplier networks. „Sometimes it`s absolutely frustrating,” said Dr. Christopher Crow, president of Catalyst Health Network, based in Texas, which brings together about 600 primary care providers. For more information on this topic or to find out how Baker Tilly specialists can help your company move to value-based contracts, contact our team. Bloomfield`s, Conn.` Cigna`s resident insurers have acknowledged that all the measures it uses for value-based contracts would not be relevant to suppliers, so it has set a minimum volume threshold for the 16 measures it uses for its standard quantity. Suppliers must meet the threshold in order for the measure to be included in their contract. „We`re going to start to gain value, but we`re not going to get there if one side moves forward and the other doesn`t,” he said. „Partnerships must be sincere and useful. Not only is there a press release that says we are moving towards value. In the developing health market, payers, providers and life sciences organizations are now cautiously relying on VBC agreements to ensure that the most desirable outcomes for patients and finances are achieved.

While the initial objective of VBCs is to redistribute risk to all parties, life sciences firms generally have the largest number to lose and, therefore, bear the greatest risk in these agreements. Because payers and suppliers can control access to a product or technology, life sciences companies must demonstrate the value of their product in order to obtain favourable coverage decisions. In this new type of activity, if the product does not have the data needed to support a history of strong value, the life sciences company risks losing access to a significant number of patients in a plan or hospital system. Despite this risk imbalance, the upside potential remains for all parties participating in VBC, particularly life sciences companies. Nevertheless, imperfect insurer data should not be a major obstacle to the success of value-based payment models, argued Kevin Sears,