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Partners in value, benefits for all

Learn insights and resources to help health care executives make strategic decisions and collaborate innovatively — delivering benefits for all.

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How can payers and providers grow with value-based models?

Learn why collaboration is step one to creating sustainable value-based models that drive growth.

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Discover the statistics and success stories of how value-based care is transforming the consumer experience and the health care ecosystem. Find out how payer and provider collaboration can equitably distribute risk and rewards across industry partnerships.

 

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  • Long Description

    What progress is being made in moving to value-based models?

    34 percent of total U.S. health care payments were tied to alternative payment models in 2017, increasing from 23 percent over two years.1

    Value‐based reimbursement is projected to make up 50 percent of provider revenue by 2020.2

    "The report's findings reinforce our understanding that there is sustained, positive momentum in the effort to shift health care payments from traditional fee-for-service into value-based payments." –Mark McClellan, Co-Chair, LAN Guiding Committee (PR Newswire, October 22, 2018)

    90 percent of payers indicated that Alternative Payment Model activity will increase. Zero indicated it will decrease.3

    Source notes

    1. Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage and Medicare Fee-for-Service Programs, Health Care Payment Learning & Action Network report. October 22, 2018.
    2. Managing Revenues in a Value-Based Care Environment. Frost and Sullivan. March 26, 2018.
    3. Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage and Medicare Fee-for-Service Programs, Health Care Payment Learning & Action Network report. October 22, 2018.

    Are value-based models impacting the Triple Aim?

    Providers and payers are making headway toward achieving the Triple Aim through value-based care initiatives.

    Cost of care

    42 percent of Insights Council members strongly agree or agree that value-based contracts significantly improve the quality of care.1

    74 percent of provider financial executives reported positive financial results from value-based payment programs.2

    Quality of care

    46 percent of Insights Council members strongly agree or agree that value-based contracts significantly improve the quality of care.3

    Consumer satisfaction

    73 percent of payers achieved improved consumer engagement and 64 percent of them reported improved provider relationships.4

    Source notes

    1. NEJM Catalyst Insights Council survey. July 2018.

    2. HFMA's Executive Survey: Value-Based Payment Readiness. Sponsored by Humana. September 2017.

    3. NEJM Catalyst Insights Council survey. July 2018.

    4. Finding the value in value-based care: The state of value-based care in 2018. Report commissioned by Change Healthcare. June 2018.

    Value-based case studies for payers, providers and consumers

    Payer/Provider Case Study: Temple University Health System

    Challenge: Maximize return on population health investments over next seven years, with an emphasis on speed to "disrupter" status

    Solution: Identify value-based opportunities, develop plan to maximize returns and create a roadmap for value-based, at-risk contracting

    Collaboration sweet spot: Data sharing and advanced analytics enable quick and clear decisions to create win-win payment strategies

    Results:

    • Identified $4–5 million in annual savings opportunity for members having the top four chronic conditions
    • Invested in medical neighborhood model for chronic care patients
    • Exploring analysis to improve risk adjustment and commercial payer contracts

    Provider/Consumer Case Study: Cleveland Clinic

    Challenge: Differentiate Centers of Excellence and specialty care programs

    Solution: Build retrospective bundled payment program targeting specific disease states and focusing on quality

    Collaboration sweet spot: Shared data to understand the full continuum of care

    Results:

    • Improved care coordination and consumer experience
    • 7–10% savings across 300 cases/quarter at eight hospitals
    • Continued program evolution – more custom retrospective and prospective bundles

    Payer/Consumer Case Study: UnitedHealth Group

    Challenge: Enhance care coordination, improve outcomes and deliver greater value

    Solution: Create spine and joint bundle payment program that rewards health plans and all providers involved — to improve coordination, outcomes and costs

    Collaboration sweet spot: Bundle definition, network refinement and care coordination

    Results:

    • Improved care coordination and outcomes for consumers
    • $18 million in improved outcomes savings across >115 employers
    • About $18K savings per procedure
    • Program expansion to 37 markets from 28 in 2016

    Payer/Provider/Consumer Case Study: Benevera Health, a payer-provider joint venture

    Challenges: Better identify at-risk individuals and improve use of care team resources

    Solution: Analytics and care coordination capabilities helped

    • Focus care team resources
    • Create patient assessments and holistic care plans
    • Better manage populations with intuitive workflows and performance dashboards

    Collaboration sweet spot: Shared data to improve care and increase consumer satisfaction

    Results:

    • 95% patient satisfaction rate
    • 75+% Net Promoter Score
    • 35% decrease in medical spend for high-need patients

    Where can payer-provider collaboration accelerate value?

    Health executives' top payer-provider collaboration areas align to value-based goals.

    (Source: Modern Healthcare Survey Briefing, Feb. 2019)

    Strategies to impact total cost of care: 52%

    Value-based agreements: 48%

    Quality improvement: 46%

    Care coordination and management: 45%

    Guiding patients to appropriate care settings: 42%

    Population health management: 42%

    Areas align to top value-based adoption barriers of "ability to operationalize" and "willingness to take on financial risk"

    Source: Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage and Medicare Fee-for-Service Programs, Health Care Payment Learning & Action Network report. October 22, 2018

    What components are key to value-based success?

    Value-based care strategy

    Collaboration sweet spot: Share data and knowledge to develop value-based objectives, financial models and care paths that share risk and benefits

    High-performance network management

    Collaboration sweet spot: Share access, quality and cost data to build networks that enhance coverage, physician engagement and contract performance

    Population health management and quality

    Collaboration sweet spot: Link clinical, claims, pharmacy, behavioral and socioeconomic data to create a holistic population view and enable better care decisions and coordination.

    Enterprise risk and financial management

    Collaboration sweet spot: Provide transparency into analytic insights to develop win-win, value-based contracts, results and refinement opportunities

    Product leadership

    Collaboration sweet spot: Partner to assess the market and design value-based products that better serve local/regional consumers' and population health needs

    Organizational change and talent acceleration

    Collaboration sweet spot: Develop change management programs together and identify champions across organizations and reward talent

    Data management

    Collaboration sweet spot: Integrate disparate data from across the health ecosystem to provide transparency and jointly set value-based objectives and performance standards

    Consumer engagement

    Collaboration sweet spot: Inform consumers’ health care decisions by aligning payer and provider digital tools, navigation programs and notifications

    Analytics and reporting

    Collaboration sweet spot: Share performance results and analytic insights to partner on closing care, cost and performance gaps

    Enabling technology

    Collaboration sweet spot: Partner to better integrate data, systems and tools for improved efficiency and transparency within workflows that enable a more seamless consumer experience

    Business operations excellence

    Collaboration sweet spot: Design business processes that eliminate friction in the system and that are compatible across payers and providers

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"Leaders realize the fastest way to make significant and sustainable progress toward value is through payer and provider partnerships."

— Erik Johnson, Vice President of Value-Based Care, Optum Advisory Services

As seen in “Shared challenges — shared opportunities” survey brief. Modern Healthcare Custom Media, February 2019.

Read the brief

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Resources for payer-provider leaders

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