Value-Based Transformation
Value-Based Transformation
Foundational excellence and strategic change for healthcare providers on the value-based transformation journey
Value-based care (VBC) challenges traditional provider payment and care delivery models, thus requiring changes to the organization’s business model and its enabling capabilities. Baker Tilly developed a tool that assesses a provider organization’s level of readiness to implement VBC contracts while identifying key transformation activities required to realign and optimize risk-based strategies, processes and enabling tools.
Market trends: The journey to value based care
Moving to value-based care is imperative, but also complex.
Assessing value-based readiness
Our goal is to assist organizations in:
- Understanding their current state readiness and foundational strengths
- Determining what areas need to be enhanced for foundational excellence, and how to enhance for value-based care payment models
- Developing an agile plan to implement changes, whether those are foundational or to prepare for risk
- Realigning strategy and optimizing supporting processes to drive performance excellence
- Implement the change in workflows and enabling capabilities
Contact Baker Tilly to learn more about how we can help your organization prepare for a value-based transformation.
Payment model continuum: setting the context
The value-based readiness matrix
Understanding the business model components
Culture/strategy
Define the current culture and strategy of your organization in relation to your future goals. What are the strategic levers your organization will emphasize in the transition to new models of reimbursement and care delivery?
Sharing information throughout your network, with third party providers, and with your payers to enable the right information in the right place at the right time is one those strategic levers.
Learn more about VBC information sharing
Physician leadership and organization
Fee for service models tend to favor development of silos and a visit-based (encounter) focus in the physician organization. To prepare for value-based care programs that emphasize overall outcomes requires aligning the physician organization with new cross-continuum models of care. The physicians are a key component in effective implementation of care strategies and new reimbursement models. Evaluating the effectiveness and inclusion of physicians in your organization’s leadership helps increase the likelihood of implementing initiatives successfully.
Learn more about VBC physician engagement
Care delivery
Value-based care programs tend to measure and reimburse for patient-centered approaches to care delivery. The focus is less on specific encounters and more on the management of patient conditions across the continuum of care – from presentation in an urgent or emergent setting to inpatient care and discharge to outpatient clinic follow-up and home health care support.
Evaluating how your care delivery models need to change to support this continuum of care is critical to meeting your value-based contracting performance, quality, and outcome metrics and achieving financial success.
As your care delivery strategies evolve across the continuum, engaging with your patients beyond the visit becomes essential to your success. How do you build an effective patient engagement strategy?
Learn more about VBC patient engagement
Network organization
As with the physician organization, it is important to look at the entire network to align it with value-based requirements on care coordination activities across the continuum that focus on a patient-centric model. How will your organization communicate and manage the patient from ED to inpatient to outpatient clinic to home care?
Learn more about VBC network organization
Payer relationships
As with the physician organization, it is important to look at the entire network to align it with value-based requirements on care coordination activities across the continuum that focus on a patient-centric model. How will your organization communicate and manage the patient from ED to inpatient to outpatient clinic to home care?
Learn more about VBC payer relations
Revenue and compensation
As value-based programs change how the organization is reimbursed for care delivery, evaluating your current compensation models can help you address any current issues and help you understand what changes will be needed to effectively compensate your staff under different reimbursement models.
Driving value with integrated care coordination
Establish an integrated model of care coordination across the continuum – breaking down historical silos such as ED, inpatient, outpatient, home health, etc. – in order to drive a patient and outcome-focused approach to care delivery and management that drives quality performance. An integrated care model supports and engages the patient beyond the point-of-care, ensuring higher compliance and increased positive outcomes.
Terminology: defining the elements of value-based assessment
What is risk?
- Financial risk of varying degrees entered into via contracts between providers and payers.
- Risk may shift from payer to provider depending on the type of arrangement, such as alternative payment models with shared savings or population-based arrangements.
- Risk can be upside-only (payments can only increase as providers achieve key metrics); or include down-side risk (provider payments may also decrease). As the organization assumes more risk, the potential (upside and downside) increases.
What is readiness?
- Readiness is an assessment of the organization’s strategic and operational priorities necessary for healthcare providers to assume financial risk in value-based care arrangements.
- Risk-based contracting can improve the financial health of the organization, while simultaneously improving quality and patient outcomes.
- Risk readiness ensures the foundational excellence of the organization in the overall transformation road map to risk-based programs.
Real-time data to drive informed decisions
Baker Tilly has partnered with IBM and has licensed their IBM® MarketScan® Research Databases – one of the largest proprietary U.S. claims databases. We define four stages of VBC and transformation, including feasibility, contract design, program enablement and ongoing contract monitoring. Our IBM partnership will inform each of these steps and mitigate your risk of entering VBC agreements that could fail. We will do this by modeling various scenarios that could occur in a program and educate all parties on its benefits, challenges and opportunities for improvement. Along with the IBM® MarketScan® dataset, Baker Tilly is able to help you benchmark against your competition for metrics like average payments for procedures, utilization patterns, longitudinal episode-of-care models and more.
Making informed, data-driven decisions is key to implementing an effective VBC program. Contact Baker Tilly now to help you understand your current state readiness on your organization’s value-based transformation journey.
Managed care - evolution to value-based contracting
The evolution to value-based contracting requires a road map that aligns the necessary programs, projects, and initiatives by strategic importance and determines relative timing based on operational goals and program prerequisites. Establish an effective steering committee to provide a thorough transformation road map based on your organization’s goals. Bake Tilly helps by conducting a comprehensive readiness assessment of all aspects of your organization that identifies areas of foundational strength while clearly describing where the organization needs improvement to maximize its success in value-based contracting.
Provider engagement strategies for value
An effective provider engagement strategy drives success in a value-based environment. Your physicians will need involvement and guidance in defining new, equitable payment models based on outcome-driven quality and performance measures. By developing a comprehensive engagement strategy, you will generate the buy-in and support necessary for physicians to deliver top performance – driving higher financial returns and better patient outcomes.