Session 023: A Common Vision of Value-Based Care: Case studies of Payer-Provider CollaborationValue-Based Care: Case studies of Payer-Provider Collaboration In the current value-based care marketplace ... reimbursement models that tie payments for care delivery to the quality of the care provided. The purpose is clear ...
Description: In the current value-based care marketplace, there are various reimbursement models that tie payments for care delivery to the quality of the care provided. The purpose is clear – change reimbursement to focus on value by rewarding better outcomes and lower spending. However, implementation it is complex, and many challenges emerge during this transition for both providers and payers.Providers often lack sophisticated actuarial capabilities or clear understanding of the connection between finance and clinical operations. For these reasons, they enter risk arrangements without knowing how to strategically manage and mitigate risks and fully transfer the reimbursement changes into clinical decisions. For payers, a truly viable value-based payment model that rewards the most valuable providers needs a multidisciplinary approach and a solid financial model. Such a model also requires transparency and a clear transitional road map for providers to encourage participation and collaboration. In this session, we will discuss lessons learned through case studies of working with both providers and payers on value-based care issues. We will illustrate the current state of the complex financial structures by presenting examples of value-based financial models, feasibility analyses, and strategies to design a payment model beneficial to both providers and payers. We will also explore the clinical collaboration necessary to make it all work, as well as present some best practice strategies to facilitate strong payer-provider collaboration.Hide
- Authors: David Hanekom, Maureen B Tresnak , Fan Zhang
- Date: May 2019
- Competency: Strategic Insight and Integration
- Topics: Health & Disability>Health care quality; Health & Disability>Payment models