Value Based Care Revenue Enhancement
Value Based Care Payor Contracting
VBC Services Summary
We optimize your revenue per patient while balancing risk-to-reward dynamics with value-based care contracts.
VBC Payor Contracting (Caps, Shared Savings, Risk contracting economics)
Services Description: Assist specialty and primary care practices in improving or implementing VBC contracts with payors or Risk Bearing Entities (‘RBEs”). VBC contracts can range from fixed per-member capitation, quality bonuses, upside Shared Savings, to global risk economics.
Services we provide for specialty practices:
1. Existing VBC contracts: Review current arrangements (often capitated deals with MA plans) to understand effective reimbursement rates and compare to market benchmarks. Advise on contractual terms and manage negotiation process with payors and/or RBE organizations which the practice is seeing members on behalf of.
2. New VBC contracts: In addition to MA or ACA payors, specialty practices often have significant patient volume attached to RBEs in addition to payors. RBEs are risk taking MSOs, primary care organizations and/or ACOs which take risk on their populations. We review patient volume trends and quantify the cost and quality of services provided to determine if a VBC economic relationship would be beneficial between the practice and specific payors or RBEs.
Value Based Care Strategy
Services Description: Given healthcare’s shift to VBC for many populations, understanding your practice’s exposure to these populations through your payors and other partnerships with MSOs, ACOs, IPAs, etc. (Risk Bearing Entities) is critical to maintain and growing your revenue. We can help you begin the journey to developing incentive-based payment structures that unlock significant economic benefits to reward the PCP practice for high-quality performance. This includes Surplus Sharing Reimbursement Structures, along with Shared Savings Agreements.
Services we provide: We provide the following five products for Value Based Care Strategy and Consulting:
iv. Managed care strategy and payor relationship development
ii. Clinically Integrated Network (“CIN”) and ACO formation, operations assessment, and network optimization
iii. Provider network development
v. Care management and clinical redesign