Shweta Shanbhag, Director, Product Strategy, Apervita
Stephanie Graham, Vice President of Payer Innovation, Apervita
Value-based contract (VBC) models continue to emerge, with the goal of reducing cost and maintaining or improving quality outcomes for patients. A successful model design places shared accountability on both payers and providers to lower the cost of care and ensure optimal quality during the measurement period. This is typically achieved through a shared accountability approach. The design establishes a win-win scenario for both the payer and provider, by sharing in any realized savings if a certain quality threshold is achieved, or lose-lose scenario if the cost and quality targets are not achieved.
A critical factor to ensure a win-win scenario is shared analytics, data, and information to guide the payers and providers to areas of opportunity and improvement unique to each provider group, during the measurement period, and directly tied to the terms of each value-based contract. However, there are many pain points between the payer and providers leading to friction and a lack of collaboration:
- Lack of a single shared platform for all VBC-related reporting: Payers and providers do not currently have a shared source of analytics to guide performance improvement of their value-based contracts. This results in tremendous friction between the payers and providers and the focus becomes aligning on the performance calculations and results as opposed to improvement during the year. Ultimately, the disagreement over performance reporting can lead to disputes over the final settlement results.
- Everyone wants more data, but rarely knows what to do with it: Even when reports are produced by payers and shared with provider groups, they may be voluminous, but not actionable due to their static nature. Unfortunately, this often results in an overload of reports and information to all provider groups and a challenge to identify calls to action, leading to a lack of engagement.
- Diluted value: Reporting is time-consuming since it’s largely manually produced, so analytics are often templated for all provider organizations, disregarding the uniqueness of the provider group, and diluting the relevance or value. This limits the ability to identify specific areas of potential performance improvement or calls to action for any individual provider.
- Lagged information: The effort to produce relevant, customized analytics can be significant for a payer and provider, resulting in less frequent analytics, and therefore lagged information. This means less value-add to the provider groups because they cannot enact change fast enough or course correct performance during the measurement period.
There are plenty of reports and analytics that can be produced and analyzed by payers and delivered to providers, but these analytics should be available regularly, unique to each provider group’s scenario, at the right level of information, tell a story to call out specific insights, suggest calls to action to improve performance, and tie to the terms of the value-based contract.
Putting Irrelevant & Lagged Analytics To Rest
Apervita offers a cloud-based solution that provides analytics and information to connect financial performance to actionable intervention that tells a story by guiding payers and providers on how to improve performance under their value-based contract terms. Payers and providers have access to the same set of performance analytics for their value-based models via direct log-in access to the Apervita platform, including shared views of performance analytics, opportunity identification, and dashboard visualization to highlight calls to action.
Quick, detailed analyses no longer have to be one-size-fits-all. The dynamic nature of our solution creates a platform for customization unique to each provider group or scenario with a few single clicks to a more granular analysis. With Apervita’s solution, a customized analysis for a specific provider group or service category is now a quick drill-in through the data versus multiple data pulls and an administrative burden on the payer or provider.
The data can be analyzed in many ways to determine what might be driving performance. For example, quickly drill down into types of service categories, provider groups, and clinical categories, or view a provider group’s utilization performance compared to a risk-adjusted high performance benchmark and analyze the facilities or site of service that might be driving the highest utilization. Contractual targets and multiple risk-adjusted benchmarks can be applied in the performance comparisons. Benchmarks are risk adjusted using clinical criteria to create a clinical risk profile for each member by condition and severity level so they can be used as a guide to show how performance can be improved. The benchmarks are dynamic and reflect each population under review. An additional advantage of the flexible platform is the ability to save the customized analytics in dashboards, which are automatically updated with each data refresh.
We believe shared analytics will not only help facilitate better relationships between payers and providers, but will also promote value-based contract success for both parties.
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