Quality and Value-Based Care

Value Based Care Value-based payment can be a winning proposition, so long as an organization has all the right pieces in place.
In the new era of value-based payment contracts, health systems will require a business and clinical model designed to help them assume increased risk. If value-based payment contracts with a health system’s sponsored accountable care organization (ACO) or clinically integrated network (CIN) are to be more than simply the next incarnation of pay-for-performance, they must lay the groundwork for a comprehensive population health management strategy, with all the pieces in place to effectively manage the cost of care.
Balance the use of traditional and new metrics
The challenge for most health systems pursuing the value-based payment model is that they must do so while continuing to operate in a fee-for-service (FFS) world. That means they must continue using traditional FFS metrics focused mainly on volume while also developing new metrics and skill sets, such as:
- Analyzing measures such as episodes of care for chronic conditions, utilization rates and practice pattern variations, deviations from care pathways and errors in outcomes reporting
- Becoming proficient in benefit design, product pricing and curation of care networks
- Understanding how the benefit design and payment rate changes described in the contracts will affect utilization rates and financial performance.