Healthcare is undergoing a significant shift from a volume-based model to one focused on value. New cost of care and reimbursement models mean organizations must think more strategically about their value-based contracts, including their partners in risk sharing and overall performance. Effective financial success in the accountable care environment now hinges on providers’ ability to manage revenue and risk differently than they ever have before. The right insights and data are required to enable accountable care organizations (ACOs) and health systems to make the best decisions possible to secure effective reimbursement and remain competitive in an evolving landscape.
The MedInsight® Value-Based Care (VBC) Contracts application provides ACOs, health systems, and independent physician associations (IPAs) with a full view of their financial performance across different types of VBC agreements. Interactive dashboards enable users to accurately model the potential success of each contract, set individual targets, and monitor their progress over time. With VBC Contracts, your organization can benefit from the following capabilities to monitor revenue and manage risk:
Maximize profitability
Gain insight into your organization’s financial health and identify areas to increase revenue generation with a clearer understanding of total assigned beneficiaries, revenue, and overall at-risk expenditures.
Rock-solid data confidence
Leverage a reliable and accurate application that draws from trusted Milliman methodologies and extensive experience in loading Medicare CCLF data feeds, as well as commercial/Medicaid data feeds.
Holistic population views & risk-unit level detail
View key risk contract inputs like membership, risk score, claims, and target at the ACO or individual provider level. Monitor performance to ensure savings and losses are distributed more equitably among all participating providers.
Comprehensive projections
Calculate and compare the performance of settlements for past, present, and future years. Our tool uses a variety of robust actuarial techniques to perform settlement projections for an ACOs risk arrangements throughout the life of the contract.
Interactive modeling
Model impacts to expenditures and targets to see how changes could impact settlement revenue from commercial, Medicare Advantage, Medicare FFS, and Medicaid risk contracts. Set up scenarios based on user input and export them into Excel for further analysis.
VBC Contracts in action
Contracts dashboards
Improve contract and cost management
Gain a centralized view of all total cost of care (TCOC) value-based contracts for ACOs and take your analysis to the next level by comparing performance at the risk unit level. Whether it’s a provider group, region, TIN, or any other risk unit, Milliman’s robust actuarial methodology empowers your organizations to project savings or losses for the current performance year and identify additional opportunities for optimization.
Optimize efficiencies and outcomes
Leverage a single source of truth that aligns payer and provider data and eliminates manual modeling. Access multiple years’ worth of data effortlessly, allowing your organization to analyze trends, identify areas for improvement and make data-driven decisions. Stay ahead of the competition with more reliable data management and reporting capabilities.
Increase performance and profitability
Access a wealth of historical data to make informed decisions that optimize your overall performance. Create projection scenarios and explore potential savings or losses for the current performance year. With comprehensive insights, you can make strategic decisions to maximize your financial outcomes.
Use cases: Payer & provider
Provider
Financial performance management & settlement forecasting
Gain insights into big-picture financial performance using actuarial methodologies and compare current year projections to previous years
Advanced contract management
Optimize financial performance across alternative payment agreements and compare contract payments to actual costs
Increased operational efficiency
Develop various scenarios accessible to all team members, featuring detailed settlement and risk information, with the option to export to Excel for further custom modeling
Payer
Standardized reporting & transparency
Deliver top-quality, standardized reporting to provider partners, eliminating the need for in-house development
Unified performance monitoring & insights
Access comprehensive performance insights for various contract types and providers, all in one convenient location
Accurate financial reconciliation
Efficiently determine year-end settlement values to streamline your financial reconciliations
Relevant resources
How digital transformation drives value-based care
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2024 Outlook: Five key analytic capabilities shaping VBC
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Leading the way in value-based care: Best practices for mitigating risk
The healthcare landscape is rapidly evolving to one in which value and accountable care are the predominant measures for delivering high-quality, affordable care. It is an evolution that has been underway for more than a decade, but recent years – and the demands of an aging population – have brought transformation at a rapidly growing … Leading the way in value-based care: Best practices for mitigating risk
The right data for every model of value-based care contracting
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 … The right data for every model of value-based care contracting
Reducing risk to drive VBC success for ACOs
As value-base care (VBC) progresses, accountable care organizations (ACOs) face a significant challenge in balancing the quality of care and financial outcomes while taking on increasing financial risk. This task becomes even more difficult without a comprehensive understanding of patient populations and overall performance, making it challenging to sustain value-based care effectively. ACOs typically have … Reducing risk to drive VBC success for ACOs
Reporting Framework for Value Based Care
As the cost of healthcare continues to rise, both payers and providers continue the “triple aim” of delivering effective quality care while managing their costs. Value based care (VBC), or value based reimbursements, has emerged as an effective mechanism for achieving this goal. In fact, based on estimates developed by National Business Group on Health, … Reporting Framework for Value Based Care