The right data for every model of value-based care contracting

By MedInsight

3 October 2023

How MedInsight Supports Organizations on the Glide Path to Risk

For healthcare provider organizations navigating the array of alternative payment models in use across all phases of value-based care contracting, the complexity can be daunting.

From small physician groups operating on a largely fee-for-service basis to health plans managing the claims of tens of thousands of members, the managing of risk can differ significantly from one payment model to the next. For organizations navigating all of them at once, the challenges of managing care and economics across all revenue verticals are enormous.

At the same time, the system is coming under growing consumer demands that will add new pressure on value-based care margins. As millions of baby boomers move into their retirement years, those demands are only going to increase.

But no matter what the demographics bring or where your organization currently falls on the continuum, from the least to the greatest share of premium dollars at risk, the ability to manage your margins, operate efficiently, and capitalize on opportunities for growth is intrinsically linked to the quality of your data and your ability to use it.

Insights for every level of provider risk

At MedInsight, we partner with provider organizations at every stage on the path, with strategic advice and solutions customized to your business model, your goals, and your risks. We provide the data, analytics and insights that leave you better positioned today for managing the chaos of multiple payment siloes and better positioned tomorrow for taking on bigger things.

MedInsight data and analytic tools can reduce risk and drive better outcomes for whatever flavor of alternative payment models you’re managing, along with scaling your business for where you want to be.

Achieve more with yay-for-performance insights

Even when risk is low, in a pay-for-performance healthcare practice for example, the right metrics can drive both quality of care and opportunities to participate in bonuses based on metrics like reduced hospital readmissions. The combination of healthcare data analytics training and certification with simple reports and cost, utilization and benchmark metrics can provide key insights that reduce risk and improve patient outcomes.

Meet your targets with bundled payment tools

As risk increases, the need to quantify costs, reduce volumes and calibrate against payer-established benchmarks grows. Provider groups earning bundled payments for comprehensive care are incentivized to reduce the costs for comprehensive treatment over a defined period for things like maternity care or joint replacement.

Master your benchmarks for shared savings success

Higher risk payment models, like Medicare’s Shared Savings Program (MSSP) and accountable care organizations (ACOs), require providers to guard against overspending and work to stay within year-end benchmarks in a shared risk model that can end with recouped savings – or money owed back to the payer.

Lower your capitated payment risks

Capitated payments, used by Medicare direct contracting and under some Medicare Advantage plans, are a high-risk, high-reward payment model that requires careful modeling of risk.

The right analytics will enable providers under both shared risk and capitation payment systems to model complex risk performance data and focus on containing network leakage and adhering to provider performance metrics.

Drive health plan efficiency & growth

The health plan payment model represents the high-end of the risk spectrum, with the provider group reaping the full premium for covering a group of patients, but also taking on the added responsibility of managing claims, the provider network, and utilization. At this end of the path, sophisticated population health modeling and risk model projections are key to reducing costs and volumes while also improving the quality of care.

The right tools & solutions for supporting your place on the risk path

Wherever you are on the path and wherever you want to be, partnering with MedInsight can provide the healthcare data analytics solutions you need to see where you are and where you are going.

We can support you at every step along the way, with industry leading benchmarks and groupers, a customizable ecosystem of software, solutions and tools, and the expertise to make the most of it.

With a wide selection of customized and standalone tools, our products and services are calibrated to show you what you need to know to manage the needs of targeted clinical populations, to create detailed reporting for your constituencies and to leverage the benchmarks and norms that can improve performance, drive savings, and keep you on the right path.

Speak with one of our data analytics experts to learn why leading healthcare organizations rely on MedInsight software for insights that improve both patient outcomes and financial health.

Contact us to learn more about healthcare data analytics