Program Strategy

Program Strategy

Multiple value-based care (VBC) programs that are targeted at different provider types and groups of members are likely required to meet outcome improvement, quality improvement, and cost trend reduction objectives. A comprehensive strategy for the definition and deployment of VBC programs is critical to success.

Related:

  1. Program Strategy
  2. Core Operational Capabilities
  3. Business Implementation
  4. Delivery Excellence

Program Strategy

Value-based 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 value-based 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 value-based program pipeline – we help identify cost, quality and care outcome improvement opportunities and develop backlogs of candidate VBC programs.

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) – Baker Tilly has 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 value based care program.

Program expansion

As value-based 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 value-based 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 VBC programs – we help enable the “productizing” of value-based care 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 benefits.

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.