Value-Based Payment

Value-Based Payment

When managed appropriately, value-based arrangements can align incentives and drive financial success. To succeed, providers must handle contracts wisely, engage physicians, implement the right care improvements, track performance, and then do it all over again.

Veralon can help you implement successful value-based payment programs. We can analyze and optimize single contracts, or look at the impact of multiple contracts simultaneously, helping your organization to gain the same confidence with value-based payment that it has with fee-for-service payment.

Veralon’s BPCI clients have been successful in achieving overall average savings of 15%, by reducing readmissions by up to 45%, and decreasing SNF stays up to 30%.

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We have the extensive domain knowledge, strategic perspective, significant skills in data analysis and management and deep understanding of clinical and financial issues to support you in achieving success with value-based payment.

We can assist your organization with:

  • Designing shared savings or risk-sharing arrangements: including analyzing current population health costs across the continuum of care for the population using your participating primary care physicians; projecting feasible savings and the amount that will accrue to the risk-sharing entity; estimating the impact on utilization and the bottom-line, and determining physician incentive payment mechanisms.
  • Selecting target episodes for bundled payments, and implementing savings programs: including selecting target episodes by diagnostic group and span of care; establishing risk-adjustment mechanisms and gain-sharing models; identifying the most appropriate quality metrics and standards for improvement; and modeling financial impact and potential savings available to share with physicians. Veralon will help you identify savings opportunities and how to pursue them, and can check and reconcile final payment/savings computations prepared by CMS or by health plans.
  • Implementing pay-for-performance: Where shared savings or bundled payment arrangements are too complex, Veralon can assist you to pursue pay-for-performance arrangements. We can help structure and negotiate contracts to achieve the benefits of aligned interests in quality standards and cost reductions, by:
    • Assessing contract terms
    • Determining the budget neutrality of a new payment methodology
    • Considering the impact of severity and similar adjustments
    • Evaluating physician fee schedules
    • Determining how to distribute bonus pools

All of these value-based payment mechanisms require a data infrastructure that can support performance monitoring and incentive payments. We can determine the specific data analytics needed to support each value-based contract.

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