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:
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.
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.