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 service leakage.
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 contracts.
Holistic Population Views
Modify care management strategies and interventions based on the history and characteristics of at-risk populations, including membership, risk score, and claims by Medicare Eligibility Category (MEG).
Comprehensive Cost Projections
Calculate the projected performance of settlements over multiple performance years (historical, current, and future) and compare the revenue from fee-for-service models with value-based models to evaluate the move towards value-based healthcare.
Interactive Cost Modeling
Analyze potential cost-reduction strategies and model various scenarios to determine how modifications to their approach could affect revenue from commercial, Medicare Advantage, Medicare fee-for-service (FFS), and Medicaid risk contracts.
VBC Contracts in action
Contracts dashboards
Improve care coordination, quality, and costs
Proactively seek out and control the value drivers that will produce the most significant improvements in network performance and revenue generated from contracts.
Optimize efficiencies and outcomes
Track and monitor a portfolio of risk-based contracts, such as Medicare Shared Savings Program (MSSP) and direct contracting (DC) contracts, and eliminate the unpredictability of manual modeling and tracking approaches.
Increase performance, satisfaction, and profitability
Project and maximize return on investment from value-based contracts with increased visibility into how each of these contracts contribute to the overall revenue stream.
Use cases: How VBC Contracts can help
FFS reimbursements
Track and analyze payments received through the traditional FFS model and evaluate the financial performance tied to this payment method.
Administrative costs
Monitor and control administrative costs associated with operating expenses with deeper insights into billing, coding, regulatory compliance, and other administrative functions.
Financial planning
Anticipate future capital requirements, such as expanding facilities, acquiring new technologies, or undertaking strategic initiatives, and ensure proper budgeting and resource allocation.
Alternative payment contracts
Manage alternative payment contracts, project potential revenue streams, and assess the impact of quality metrics on the financial outcomes.
Operational efficiencies
Gain additional visibility into patient volumes, case complexity, and other factors affecting staffing requirements to optimize workforce distribution, ultimately impacting financial performance.
Value-based care resources
Bundles
The MedInsight Bundles application offers organizations participating in bundled payment programs the insights they need to efficiently manage the payment models implemented by the Center for Medicare and Medicaid Innovation (CMMI).
VBC Platform
The MedInsight® VBC Platform is designed to support Accountable Care Organizations (ACOs) focusing on VBC by delivering the insights you need, when you need them.
VBC Insights
With VBC Insights, included in MedInsight’s Value-Based Care Platform, users can effortlessly track utilization trends over time and dive into individual patient cohorts to uncover cost-saving opportunities.
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
Relevant resources
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