Succeeding in value-based care (VBC) requires more than just signing contracts. It requires a comprehensive approach that includes network optimization to help healthcare organizations provide efficient care, improve the patient experience, and ensure cost effectiveness.
All-payer open-ended claims data has emerged as a valuable tool for jump-starting better contracting in the healthcare industry. By analyzing this comprehensive data, healthcare organizations can gain insights into the true value and effectiveness of different care providers and services. This rich data allows leaders to make informed contracting decisions based on objective evidence rather than relying solely on subjective measures.
By leveraging all-payer open-ended claims data, healthcare organizations can identify high-performing providers, negotiate contracts that align with value-based care principles, and ultimately improve the quality and efficiency of healthcare delivery. This data also helps the users understand the market dynamics and identify areas where their low performing provider groups need to work on.
Healthcare organizations should follow a strategic approach to be successful in implementing VBC. Here are several steps organizations can follow to negotiate contracts that align with their value-based care goals and drive positive outcomes for patients and providers.
Step 1: Harness the power of all-payer claims data
All-payer open-ended claims data is a very powerful source of information for healthcare organizations to stay ahead of their peers. During VBC contract negotiations, organizations can use this data to gain insights into their patient population, such as low-coverage quality screenings, prevalent chronic conditions, and utilization patterns.
Additionally, analyzing the data allows organizations to assess provider performance, identify variations in care delivery and measure performance against quality metrics. By using this data-driven approach, organizations can make well-informed decisions during VBC contract negotiation to help ensure incentives are optimally aligned with their provider groups.
While the all-payer claims data has proven to be a valuable asset, many existing analysis tools fall short by offering only static, prepackaged reports. These tools often lack the flexibility and customization options needed to address specific metrics or to simulate contracting scenarios. They may provide limited insights and hinder the ability to explore data in a meaningful way.
That’s why Innovaccer has worked to develop new tools that go beyond static reports to let healthcare organizations make data-driven decisions about network composition, value-based contracting, quality management, and contract negotiations. Health organization executives can utilize this data, even if it may be five months old, to gain valuable insights into performance patterns, utilization trends, and provider performance.
Step 2: Unleashing the power of data in contract negotiations
The ability to quickly and easily analyze volumes of data can help organizations measure quality outcomes and assess cost efficiency. That can give organization executives the information and insights they need to effectively negotiate VBC contracts that address existing gaps, drive continuous improvement, and make strategic decisions, network expansion, and resource utilization.
Contract simulations and network analysis are critical elements in simplifying the process of selecting the optimal network. These technologies have shown to be quite useful in the healthcare industry, giving a virtual environment to predict and analyze diverse scenarios.
One of the major use cases for network optimization is identifying what is not working in low-performing provider groups through which organizations can pinpoint inefficiencies and areas of improvement to enhance patient care.
Simulations come in handy while identifying the best candidates for expansion. When considering expanding into new markets/specialties or scaling up operations, simulations can provide valuable insights into the potential outcomes of different expansion strategies. By simulating various scenarios, organizations can assess the feasibility, risks, and potential returns associated with each alternative.
These technologies offer a safe and cost-effective way to experiment and explore different possibilities without the need for real-world implementation. It enables organizations to better evaluate the value of different contract options, including which provider groups may perform best to enhance network performance. Insights that provide a complete understanding of the costs, risks, and potential outcomes allow organizations to help ensure contracts align with their goals.
The Road Ahead
Network optimization is critical to achieving success in value-based care. Healthcare leaders who embrace technology to get the insights they need through robust data analysis will have the information they need to optimize care networks and advance the principles of value-based care.