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.

Design

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

VBC program design must focus on the critical success factors necessary to support a sustainable health plan and provider relationship including transparency, aligned financial incentives, financial and strategic sustainability, and commitment to quality and member/patient satisfaction.

Once the critical success factors are established and agreed by both parties then the organizations should focus on the detailed business rules and capabilities required to operationalize the program.

From a health plans perspective, it is critical that program capabilities are designed to meet the specific program requirements with the flexibility to expand to future programs. Our experts can work with your organization and partnering provider organizations to design a new program using our VBC program definition methodology .

VBC program definition

The typical health plan network is likely filled with a diverse set of providers and successful VBC strategies must be aligned to a diverse set of provider types. This often results in a requirement for a robust set of VBC programs in order to truly drive network level improvements in health outcomes, quality improvement and cost trend reduction.

How we can help:

Definition of individual VBC programs – we collaborate to define the structure of VBC programs, including development of standard provider contracts, incentive models, rules that define member attribution, bi-directional data exchange, and reporting and analytics expectations.
Definition of VBC program pipeline – we help identify cost, quality and care outcome improvement opportunities and develop backlogs of candidate VBC programs.

Internal stakeholder engagement

VBC programs impact a significant amount of stakeholders across a Health Plan’s organization. Stakeholder identification is critical during program design to ensure all necessary stakeholders are properly engaged.

How we can help:

Stakeholder identification – we can identify all impacted stakeholders within a Health Plan’s organization.
Define roles and responsibilities – we can define the roles and responsibilities for all of the program stakeholders.
Program value proposition and communication – we can help articulate the definition and goals of VBC programs, and establish a communication plan to ensure all stakeholders have a clear understanding of VBC programs and their value proposition.

Marketing and sales strategy

Marketing and sales engagement is an important aspect of communicating the strategic goals, expected outcomes and incentive techniques of a VBC program to the targeted customer base.

How we can help:

Construction of internal marketing and promotion tools – we can contribute program specific content to communications materials that showcase program benefits and help provide context into the overall vision and/or advantages of VBC programs.
Creation of external marketing and sales tools – we support the creation of program specific content in marketing materials to outside provider groups, members, and employer groups that showcase VBC program objectives and positive impacts to cost and outcome.

Overall contracting strategy

Deployment of VBC programs requires consideration of the total provider relationship as contractual agreements evolve to incorporate both value based and traditional fee-for-service methodologies.

How we can help:

Definition of contracting objectives for VBC programs – we integrate value based payment models alongside base FFS reimbursement, and define pathways for providers to “graduate” to increasing amounts of financial risk sharing and downside risk over time.
Economic modeling – we can support development of models that drive assumptions across all types of reimbursement provisions in place with a given provider to allow a focus on how different contracting levers interact with each other.

Program expansion

As VBC programs are deployed to an initial list of prioritized providers, a health plan can begin to focus on program expansion and evolution to allow additional providers to be successfully targeted. As provider coverage grows, enhancements and extensions to the design of existing VBC programs are likely required.

How we can help:

Enhance existing VBC program definitions – we support program modifications to incorporate variations in the base designs for new provider types or geographies (e.g. independent physician vs. integrated delivery system) and evaluation of model changes to support providers who have variability in the sophistication of their technology capabilities.
Scale Value Based Care (VBC) programs – we help enable the “productizing” of VBC programs, designing approaches to embed programs in network design, benefit definition and cost share/steerage incentives.
Definition of member and provider experience requirements – we prioritize the definition of member and provider experience requirements that can increase program adoption and drive intended program benefit.

Standard contract development

VBC programs often represent new contracting requirements for network management organizations.

How we can help:

Coordination between multiple stakeholders – we support cross collaboration of network, legal and provider group teams in the development and approval of standardized contract templates and supporting materials (e.g. program manuals). Helping to ensure an end-to-end feedback loop from contract creation to signature for all stakeholders.
Support standard agreement language development – we assist in the development of standard VBC contract language to ensure clear and concise descriptions of program definitions, including aspects such as data sharing, clarity on the payment methodology utilized, and articulation of the valuation approach of the financial incentive models. This may include restructuring or expanding existing contracts to include VBC provision.

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.
Feasibility
Value Based Care program initiation requires defining program objectives that are feasible for your organization and partnering organizations. Baker Tilly can work with you to help define objectives and identify gaps necessary for closure to pave the way for success of new Value Based Care programs.
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.