How Leveraging Physician Rosters & Sharing Contract Terms Promote Payer-Provider Collaboration

 
Shweta Shanbhag, Director, Product Strategy, Apervita
Shweta Shanbhag, Director, Product Strategy, Apervita
Stephanie Graham, Vice President of Payer Innovation, Apervita
Stephanie Graham, Vice President of Payer Innovation, Apervita
There’s no debate: Management of value-based contract models is more complex than fee-for-service models. There are financial, utilization, and quality metrics that must be met, many contract terms and methods that determine what is in and out of scope, and risk that is shared between payers and providers. It’s difficult to anticipate what the final settlement results will look like. The lack of insight is concerning and intimidating when dollars are at risk, and limits the interest and adoption of value-based contracts.

Wouldn’t it be nice to understand the performance of the value-based contracts during the performance period, as the data is emerging? The contract terms and methods are critical in the calculation of the final reconciliation, so why not also apply those key terms to emerging performance results and analytics during the performance period? By doing so, both payers and providers have greater insight into what to expect as the final results at the end of the performance period, empowering them to change course, if appropriate, during the year for more favorable results.

This is why contract terms are the foundation of QPay, our contract performance management solution. It’s not just about sharing analytics during the performance period, but sharing the most relevant analytics, and ensuring both the payer and provider have visibility into terms and methods that are being applied.

Illustration: Key Contract Terms > Performance Insights = Anticipated Settlement Results

The newest enhancement to QPay captures and stores the key terms and methods of the value-based contracts in a consistent, normalized state. This provides a summary view of the contracts, including the key terms and methods that are used to calculate the final settlement results, removing any potential dispute over terms and methods being applied. It’s also the source for the provider roster, the list of physicians at risk under the contract. The provider roster is updated monthly and is also used as the source to calculate the performance analytics.

Going a step farther, the contract terms are programmatically applied to generate performance insights that are relevant and allows providers and payers an understanding of emerging performance in context of their risk contract. Included as part of QPay are dashboards, reports, and analytics that not only depict a provider’s financial performance against their peers and benchmarks, but also to their contractual target. This approach gives providers continued visibility into trends during the performance period, reducing the number of surprises once the final settlement is calculated. It also creates open lines of communication by encouraging payers and providers to proactively collaborate on areas of potential improvement opportunity, before the end of the performance period, that may impact the performance results.

Ultimately, to ensure the payers and providers are on the same team and driving towards the same goals, there must be trust. We help build that trust. QPay empowers both payers and providers to log-in and view all relevant terms, methods, and the provider roster. Improving transparency of the key contract terms and methods, applying those directly to the performance analytics results in improved predictability of settlement results. This improves the collaboration and trust between payers and providers in these contracts, and for providers new to these models, removes the intimidation factor of the unknown, and accelerates the adoption of these value-based contracts.

To learn more, watch our on-demand webinar, Payer & Provider Collaboration: Trust Through Transparency, read our recent press release, or set up a meeting with one of our experts!

 

Stephanie Graham, Vice President, Payer Innovation, Apervita

Stephanie has deep experience in value-based payment models, healthcare policy, contract negotiations, and healthcare analytics with roles like Director of Network Contracting at BCBSMA and Health Systems Contracting at CVS Health. As Director of Network Contracting at BCBSMA, Stephanie developed the strategy, tactics, and tools for the Provider Contracting team across various hospital, physician, and health system-based contract models. As Vice President of Payer Innovation at Apervita, she serves as a thought leader to inform strategy, working collaboratively with Product to inform the product strategy, roadmap, and design, assisting Customer Operations during product implementations, and supporting Business Development in the sales process. Fun fact: She is a twin.
Shweta Shanbhag, Director, Product Strategy, Apervita

Shweta has over a decade of experience in healthcare transformation efforts. Her background includes building and managing key client relationships at healthcare providers, payers, and life science companies as well as planning strategic initiatives to meet business goals with executive stakeholders. As Director of Product Strategy at Apervita, Shweta works on understanding market needs and drivers to inform and execute on Apervita’s product roadmap. Fun Fact: Shweta is an amateur photographer in her spare time.

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