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EXECUTIVE SUMMARY

Moving along the fee-for-value continuum

Historically, risk adjustment and membership growth have been the largest revenue levers for government program payers. But that's evolving. Due to a shifting regulatory landscape, the quality bonus payment is an important new revenue lever.

Just as health plans are growing by maximizing quality bonuses, providers are seeking new ways to grow through value-based care. In moving to this model, it's increasingly important for providers to view payers as strategic partners to have the data that drives visibility into the value they deliver.

In How to combine risk and quality: Secrets from the pros, you'll learn what it takes for payers and providers to collaborate in the era of value-based care. As you analyze your own organization’s journey, you’ll want to assess your capabilities in four areas:

  • Infrastructure: having the technology in place to enable real-time analytics
  • Interventions: measuring efficacy and avoiding member abrasion
  • Field resources: engaging clinicians to address gaps in care
  • Data acquisition: leveraging EMR data with predictive models

LEARN THE SECRETS

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