Building transparency: Best practices for optimizing value-based performance reporting

Transparency plays a crucial role in value-based performance (VBP) reporting. It ensures accountability and trust between health plans and healthcare providers.  In a system where outcomes matter, clear reporting fosters better decision-making and collaboration, increasing stakeholders’ commitment to quality care. In this blog post, Milliman MedInsight Marketing Director Sarah Quinn explains the role of technology in empowering organizations and describes how a leading health plan transformed financial reporting into a powerful tool for enhancing transparency and driving value.

What are the challenges associated with value-based performance reporting?

Implementing transparent and effective (VBP) reporting aligned with program goals presents a myriad of challenges for many organizations. One of the foremost obstacles is the variability and lack of uniformity in data across different departments. This inconsistency can lead to siloed information and make it difficult to aggregate and interpret data cohesively. Various departments may use disparate metrics and reporting standards, hindering the ability to gain a holistic view of the organization’s financial performance and its alignment with overarching objectives.

Other common challenges include:

• Vague data sources: In VBP models, providers often don’t know what data is used to evaluate their performance. Reports may be in PDF format without clear explanations of formulas or adjustments, and providers may not have access to underlying data.
• Long Delays in Data: VBP reports often arrive months after care is given, making it hard to improve care in real-time. Metrics can also change after the performance period, which creates more challenges for providers to influence outcomes.
• Poor understanding of VBP models: Providers may not fully understand VBP contracts, due to lack of education or time to grasp the details.
• Unclear link to patient outcomes: Providers may struggle to see how VBP models improve patient care, leading to a lack of engagement.
• Limited resources for data action: Providers may lack time, skills, or support to interpret data and create action plans. Health plan liaisons may also lack the ability to help.
• Lack of trust in the data: Providers may not trust the data, leading them to question its value and legitimacy. This makes it hard to use the data to improve patient care.

How can advanced analytics enhance transparency, reporting & insights?

Technology has the transformative potential to elevate the transparency and effectiveness of VBP reporting, making it more accessible and understandable for all stakeholders. By leveraging modern tools and platforms, organizations can enhance trust and collaboration to significantly improve the dynamics between providers and payers. By establishing objective and transparent evaluation criteria, a more collaborative environment can be fostered. This gives payers the opportunity to demonstrate their commitment to shared accountability, which not only promotes further engagement in VBP models but also opens the door to additional risk-sharing opportunities.

“If providers don’t understand the ‘why’ to the value-based payment model, it’s going to be hard to get that engagement. Meeting metrics can start to feel more like checking a box than providing quality care. And misaligned incentives can only further drive that divide between the payer and the provider.”

– Midwest plan director of value-based programs

Moreover, transparent reporting fosters an environment of trust and collaboration that enhances provider engagement and drives strong performance. As providers gain a clear understanding of VBP models and their performance within them, they are more likely to adopt and engage with these models. This understanding allows providers to accurately plan and predict incentives and secure leadership approval for budgeting and forecasting long-term investments (e.g., care teams and care delivery improvements). Consequently, this leads to increased financial stability and predictability for healthcare providers. By leveraging trusted data and analytics, organizations can foster a culture of transparency and accountability, ultimately strengthening their reputation and impact.

How one leading health plan transformed its VBP reporting

Since 2011, one large Midwestern plan has collaborated with Milliman MedInsight to leverage innovative technology solutions for the plan’s evolving value-based program requirements, including the conversion of complex healthcare data into actionable insights and reliable reporting for healthcare providers.

To “reimagine” and improve its approach to VBP reporting, the plan implemented a multi-phase strategy using best practices that include:

• Engaging leadership: Transitioning to transparent reporting can require a significant shift. Begin by identifying where you are and where you want to be. Make a compelling case for why transparent reporting is needed. Appoint a dedicated project champion to advocate for this cause and secure the resources needed to accomplish the work. Remember, this transformation won’t happen overnight; the culture must evolve alongside the reporting changes.
• Defining the scope and project plan: It is crucial to approach the reimagined reporting as a project, likely a multi-phase endeavor spanning several years. Be pragmatic about what can be accomplished and the timeline, considering the capabilities of both internal and external stakeholders, as well as any contractual requirements.
• Preparing for internal and external stakeholders: Internal stakeholders may require as much, if not more, training and support as external stakeholders. Developing a comprehensive training plan for both groups is key for a smooth transition. A best practice is to assume that baseline knowledge of VBP models is minimal for all stakeholders.
• Gaining actuarial support: Collaboration with actuarial teams is essential. Ensure they review all reporting and training materials for actuarial accuracy before any rollout. Allocate sufficient time in the project plan for their review and potential iterations.
• Creating assets: Each element serves a unique purpose, has its own delivery method, and requires a specific level of transparency. First, determine the reporting’s objective, then establish the appropriate level of transparency to implement.
• Moving forward with implementation and beyond: Before proceeding, ensure all materials have undergone thorough review and approval by the actuarial team and other relevant internal stakeholders, as precise reporting is crucial for building trust with providers. To guarantee the project’s success, make training and education a priority, since a lack of understanding about the reporting can lead to failure. Plan the internal rollout with sufficient time to collect and act on feedback. Carefully consider the audience and timing for the rollout—for instance, whether to begin with a pilot group possessing advanced analytical skills or to align with the start of a new program year or program. Throughout the process, maintain flexibility and be prepared to make necessary adjustments.

The outcome: Reporting transformation strengthens incentives, accountability & trust

By leveraging Milliman MedInsight’s Health Cloud data architecture and data flow, the health plan acquired a powerful framework for assessing the reliability, accuracy, and completeness of healthcare data through the Data Confidence Model and significantly enhanced its reporting capabilities.

As a result, the plan was able to implement what the director of value-based reporting termed “reimagined” reporting, built around transparency, training, data sharing and accessibility to ensure alignment of incentives as well as accountability and trust.

Where can I find additional resources for building transparent VBP reporting?

Contact us to learn more about healthcare data analytics