Three healthcare professionals talking in a hallway

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.

Payment Transformation

  1. Conference

    People talking in a conference room

    Healthcare Financial Management Association (HFMA) NJ Chapter’s Annual Institute

  2. Conference

    Skyline of Austin, Texas

    Texas Association of Health Plans (TAHP) Texas Covered Health Care Conference + Expo

Value Based Care (VBC) program adoption has transformational impacts on a health plan’s organization, requiring new provider relationship models, care delivery and payment models, collaboration among internal divisions, and people, process, and technological capabilities. Enabling transformation is possible with the right approach.

    Payment Transformation Solution Framework

    Baker Tilly’s Payment Transformation solution framework consists of four unique phases, which can be leveraged individually, in any combination, or all together based on your organization’s level of VBC program maturity:

    1. Feasibility
    2. Design
    3. Enablement
    4. Monitor

    Starting with current state feasibility assessments, our team of experts work alongside your team to design and enable end-to-end future state VBC program transformations, complete with program monitoring structures necessary to scale program success.

    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 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 upon by both parties, then the organizations should focus on the detailed business rules and capabilities required to operationalize the program. From a health plan 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 programs require new operational capabilities consisting of new systems and processes as well as extensions to existing foundational fee-for-service capabilities. Enabling the new collaboration among divisions, people, provider relationship models, and new technological and operational capabilities is vital for a program's success. Our experts can help enable the people, processes, and technology required to build new VBC programs or expand existing ones. 

    Post launch, VBC programs require continuous monitoring and optimization efforts to ensure strategic objectives are met and performance does not atrophy over time. Our team of experts can work with your organization to ensure you have the necessary tools to track success and optimize performance of your VBC programs. 

    Baker Tilly’s delivery of VBC solutions

    • Improved quality of care/provider incentive alignment
    • Maximize cost efficiency
    • Establish provider trust/collaboration
    • Purposeful, innovative VBC programs

    Improved quality of care and provider incentive alignment

    Improved quality of care for members is a critical goal of all VBC programs. VBC programs can, and should, enable improved quality of care through aligning provider financial incentives to quality outcomes. This will align provider incentives to the well-established priorities around preventative care, overall wellness, and improved quality outcomes for all members. Baker Tilly can help your organization implement quality of care into new or existing VBC programs by establishing program measure definitions and measurement approaches, implementing in-house or vendor-based quality measurement calculation and reporting solutions, and enabling integrations with new or existing core program capabilities. 

    Maximize cost efficiency

    Along with improving quality of care, maximizing cost efficiency and reducing year-over-year medical trends are key goals of VBC programs. Identification of appropriate and efficient referral patterns and sites of service are just two ways that providers can help achieve these goals.

    With the help of our experienced professionals and our licensed IBM® MarketScan® Research Databases – one of the largest proprietary U.S. claims databases – our team is able to provide actionable insights and data for health plans looking to implement an effective VBC program. Our team can help your organization design and implement strategies to help your provider partners steer patients toward the most efficient sites of service and specialists with an enhanced focus on targeted member wellness and quality health. We are also able to offer your organization the most up-to-date data regarding your competitor’s claims data by using IBM® MarketScan®. In addition, Baker Tilly is able to analyze longitudinal patient journeys with episode-of-care analyses to compare against your competitors and among your own regional networks to ensure maximum cost efficiencies.

    Establish provider trust & collaboration

    Mutual trust and provider partner collaboration is required to enable successful adoption and growth of VBC programs. Baker Tilly understands the steps that are necessary to support your network providers across varying levels of VBC maturity. We can help your partnering provider launch their first VBC program or help them grow into more mature models, managing increased risk and providing clarity around program expectations and early intervention opportunities along the way. We define and plan end-to-end provider experience strategies for VBC programs that support your targeted provider’s program understanding of pre-contract through post-signature onboarding experiences, connectivity setup and ongoing business operations. 

    Purposeful, innovative VBC programs

    Provider groups may be reluctant to agree to commercial health plan VBC contracts due to the complexities and inefficiencies of managing multiple commercial health plan programs in addition to the existing CMS-mandated programs. Baker Tilly understands CMS program models and can work with your organization to design and implement standardized programs that align with CMS models to enhance program clarity for your prospective participating providers, where applicable. This will help improve your network provider participation in VBC programs and establish your organization as a leader in the VBC program marketplace.