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 our Value Optimization Solutions. 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.
The newest enhancement to our Value Optimization Solution 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 our solution 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. Our Value Optimization Solution 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.