Many executive teams of specialty provider organizations are working to iron out preferred relationships with health plans – relationships that are most often anchored in some type of pay-for-performance or value-based model. Getting contracts for these new relationships is only part of the story, actually successfully managing the contracts is other half of equation.
So what is involved with success with value-based arrangements? Last month at The 2019 OPEN MINDS Strategy & Innovation Institute, Ken Carr, Senior Associate, OPEN MINDS discussed how to build an infrastructure that supports performance management in his session, Building An Infrastructure For Data-Driven Performance: An Executive Guide For Success In A Value-Based Market. In the session, Mr. Carr outlined four types of outcomes that every organization needs to focus on to build a performance management infrastructure that is capable of supporting VBR.
Contract-Specific Performance Measures – These measures are the floor for success in measuring value. They will vary based on contracts with payers—and reflect what those payers see as the most important and most costly. Health plans and accountable care organizations will be focused on the outcomes they are accountable for to achieve to receive maximum reimbursement, making these measures paramount to the contact’s success. This may appear to be the most straightforward type of performance outcomes for a provider organization to track, but most organizations are working with multiple payers, health plans, and programs—each with their own set of measures. For an organization that contracts with multiple health plans and accountable care organizations; has multiple contracts with each of those health plans; manages a health home; receives grants with program-specific measures; and/or participates in other state programs—these standard contract-specific measures quickly add up. To manage these requirements, organizations need to have a robust technology and operational infrastructure in place for tracking and reporting on all these measures.
Routine Services & Transactions – Routine performance measures are about fulfilling the baseline expectations of running a successful business—making services convenient and affordable. Over the past decade, consumers have come to view health care like any other service, and this has shifted expectations. Organizations need to have services and programs that are easily accessible and meet the needs of consumers—the traditional processes and programs may no longer be what consumers want, making it necessary to adapt and meet consumers “where they are,” not where you think they should be. Organizations can measure their service offering by tracking the number of inquiries, inquiry response time, inquiry conversion rates, time to appointment, and service/program costs.
Great Customer Service – The health and human service market is increasingly driven by consumerism. As consumers are responsible for more of their health care costs, consumer price transparency is becoming the standard and consumer experience and engagement have become an essential component of service delivery (see 5 Reasons Why ‘Consumerism’ Must Be Part Of Your Strategy). For provider organizations management teams, measuring good customer service is about keeping consumers satisfied in all their interactions with your organization so that you can create “passionate advocates” of your brand. To do this, organizations need to develop a written service strategy to ensure consistency of consumer experience and cultivate consumer loyalty. Start this process by reviewing processes and procedures to ensure that workflow is designed from a consumer experience perspective. The goal is to make consumers feel valued and satisfied in their interactions with your organizations—not like they are simply another “transaction.”
Cutting-Edge Expertise – As the “expert”, consumers expect provider organizations to be their advisor on the latest medical science and best practices. Organizations and clinical professionals have a responsibility to understand the new science in their area of specialization and to evaluate emerging treatment models and technologies in a timely manner, and wherever possible integrate those innovations into their program models. Clinical expertise and innovation is the foundation for all clinical outcome measures, with the ultimate goal that organizations can deliver a consistent treatment model that produces consistent results without unexplained variability in clinical performance outcomes.
Is your organization ready to measure and manage under this new value equation? For most specialty provider organizations, the answer isn’t simple. Many organizations have put forth a lot of effort into getting up to speed on contract-specific performance measures, leaving behind the others. But all four of these types of outcomes fold together and build on one another—and you can’t successfully manage a value-based contract without a focus on the four as a unit.
To find out how your organization measures up, and for more advice on building an infrastructure for performance, check out the Value-Based Reimbursement Readiness Assessment. And check out some of our new resources on performance-based contracting:
- Successfully Managing Bundled Rates-The Voice Of Experience
- Where Wellness & Prevention Fit In A Value-Based World
- Implementing Measurement-Based Care-From Idea To Action
- Developing Case Rates? Better Find Your ‘Single Source Of Truth’
- Why Clinical Guidelines Matter More With Risk-Based Contracting
- Most Common Data Exchange For Office-Based Physicians – Referrals, Lab Results & Medication Lists
- Ready For Risk? How Would Your Team Answer That Question?
- The New Directions VBR Model
- VBR For Substance Use Disorder-The Optum Model
- Health Plan Business Development For The Entrepreneurial Provider Organization-Step-By-Step
For a deep dive discussion, join us on August at The 2019 OPEN MINDS Management Best Practices Institute, where Ken Carr will present, “Are You Ready For Value-Based Reimbursement? An Executive Guide For Assessing Readiness In A Value-Based Market.” During the session, attendees will also learn how to access the OPEN MINDS Value-Based Reimbursement Readiness Assessment at no cost through the Value Based Care for Behavioral Health online community.