Feasibility

Article
Payment transformation goals for the health plan industry

Kevin Coonan
MBA
Principal
David A. Gregory
Principal
Michael J. Patti
Principal

VBC program initiation requires defining program objectives and an assessment if the defined objectives are feasible for your organization and all partnering organizations.

Determining objective feasibility often requires assessments of proposed financial and care delivery models along with your organization’s current state operational and technical capabilities, external stakeholders, and marketplace factors. Our team of experts can work with your organization to help define objectives and identify gaps necessary for closure to pave the way for success of new VBC programs.

VBC program opportunity identification

With an expanding list of possible VBC programs, it can be difficult for a Health Plan to select the right program(s) for their organization. Health Plans must ensure the VBC programs they choose align with member demographics, provider specialties, and market demand for the prospective VBC programs.

How we can help:

Identify opportunities for improved health outcomes – we work with experts in your organization to identify specific provider groups or medical services with trends in poor quality outcomes to ensure the most impactful programs and providers are targeted.
Identify opportunities for cost savings – we can work with experts across your organization to analyze current network spend, define opportunities for cost savings, and align those opportunities to targeted programs.
Identify market demand – we can work with your organization to properly engage provider organizations and employer groups to help identify high demand programs.
Identify overlap with existing VBC programs – we work with your experts to analyze proposed VBC programs to identify membership overlap with existing VBC programs to ensure new programs maximize your outreach to members not currently participating in VBC programs.

Program benefit assessment

Understanding the benefits of each VBC program is critical for health plans to select the correct programs for their organization. Health plans need to select programs with benefits that align with their organizational goals, and need to ensure the program is feasible for them and their partnering organizations.

How we can help:

Define and evaluate candidate VBC program benefits – we can work with your organization to create goals with specific success criteria and timelines for expected VBC program benefits, assess feasibility of these benefits, and establish quantification of program benefits to help define expected return on investment (ROI).
Strategic objective alignment – we can work with your organization to help articulate how VBC program benefits are aligned to your organization’s strategic objectives including supporting the needs of large national accounts or other government program partners.

Strategy articulation and assessment

VBC program design and deployment requires a significant set of approach decisions and the execution of multiple priority initiatives. Program strategy must be translated into the capabilities necessary to achieve strategic objectives and define future state technology, staffing, and operating model needs to execute successful VBC programs.

How we can help:

Strategy articulation and roadmap development – we can define the strategic objectives, enabling people, process and technology capabilities, and assessments of future-state capability requirements to develop capability level roadmaps, provide business case support, create preliminary budgets and ROM cost estimates.
Operating model design – we can help establish functional operating models and required transitions plans to support execution of the strategy.

Provider selection

Specific provider partnership targets should be identified, evaluated and prioritized for VBC program inclusion in order to match programs with appropriate provider partners and increase the likelihood of program success.

How we can help:

Identification, evaluation and prioritization of candidate providers – we support the identification and evaluation of which providers to target for VBC programs and prioritize them based on factors such as provider risk readiness, network and market impacts of selection, stakeholder feedback and requests, and program level requirements.
Execution of provider risk readiness assessments and development of improvement strategies – we conduct provider level risk readiness assessments based on a framework that includes a focus on factors such as; provider alignment, data capture, management and analytics, patient engagement, care coordination/population health, financial planning and more. We can also collaborate with both health plans and providers to develop strategies for improvement.
Community Health Needs Assessments (CHNA) – We have a dedicated service offering in the CHNA space. Some of the techniques of these standard assessments can be applied to understand a provider’s care delivery requirements around specific population segments that may be the target of a given VBC program.

Payment Transformation Solution Framework

Now more than ever, customers and program sponsors are demanding better quality and more cost effective care. Value Based Care (VBC) program adoption is a strategic imperative for health plans today.

Payment Transformation
Now more than ever, customers and program sponsors are demanding better quality and more cost effective care. Value Based Care (VBC) program adoption is a strategic imperative for health plans today.
Design
Value Based Care programs design must focus on the critical success factors necessary to support a sustainable health plan and provider relationship. Baker Tilly can work with your organization and partner providers to design new program using our Value Based Care definition methodology.
Monitoring
Value Based Care programs require continuous monitoring and optimization. Baker Tilly can work with you to ensure your organization has an optimized performance for your Value Based Care program.