Value-Based Care Contracts

Optimize contract performance and profits

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

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.

Data Confidence

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.

Data Value

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).

Cost Projections

Comprehensive Cost Projections

Calculate the projected performance of settlements over multiple performance years (historical and current) and compare the revenue from fee-for-service models with value-based models to evaluate the move towards value-based healthcare.

Interactive Cost Modeling

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

VBC Contracts Dashboard
VBC Contracts Dashboard

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 curve with timely data refreshes with provides monthly updates instead of the standard quarterly updates from CMS.

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: How VBC Contracts can help

FFS Reimbursements

FFS reimbursements

Track and analyze payments received through the traditional FFS model and evaluate the financial performance tied to this payment method.

Financial Planning

Financial planning

Anticipate future cash flows of value-based care contracts to aid in proper budgeting and resource allocation.

Alternative Payment Contracts

Alternative payment contracts

Manage alternative payment contracts, project potential revenue streams, and assess the impact of quality metrics on the financial outcomes.

Learn how MedInsight VBC Contracts can help your company

Schedule a demo

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