By Matt Waltrich, RemitDATA
Whatever the future holds for the Affordable Care Act (ACA), the move from fee-for-service to value-based reimbursements is expected to continue. As this shift to alternative payment models continues, healthcare organizations are seeking ways to get the most out of whichever value-based contract they adopt.
Value-based contract models are designed to reduce healthcare costs, increase overall access to care, create quality outcomes, foster greater accountability, and leverage technological innovations. These contract models align incentives across providers, members, employers, and payers to improve quality and clinical outcomes as well as cost efficiency.
Despite the uncertainties over what’s coming next, healthcare organizations can continue to prepare while also improving their value-based contract performance.
Taking a data-driven approach to value-based payments is an important first step. As healthcare organizations including payers, Accountable Care Organizations (ACOs), and physician groups transition to value-based payment models, comparative analytics provides a view into care costs across multiple care settings, allowing the variations in treatment choices and intensity to be measured and analyzed — giving payers the data they need to make improvements and reduce costs. Comparative analytics can help simplify the management of value-based payment models.
Payers considering methods to help improve value-based contract performance should leverage comparative analytics as one aspect in implementing a data-driven approach to value-based payments. Comparative analytics can help payers:
With the growth in adoption of bundled payments, the application of comparative analytics can help guide payers toward identifying the greatest opportunities to impact cost of care. By examining historical claims data, payers can identify their highest volume and highest cost procedures (grouped by episodes of care) to establish actual prices as they seek to maximize the performance of value-based contracts.