Healthcare payers are accelerating their efforts to transition to value-based contracts as a result of increasing pressure from government and employer groups to lower costs and improve outcomes. For payers, the opportunity is clear as these models have the potential to align incentives with providers for mutual benefits. Payers that build robust and effective value-based programs will not only achieve improvements in these key areas but will also experience growth and remain competitive as employers, governments, and consumers increasingly demand affordable healthcare solutions.
However, payers are encountering substantial challenges in building VBC programs that are scalable across vastly different markets, effective in improving outcomes, and responsive to rapidly shifting conditions on the ground. While these challenges are substantial, through our work with national and regional payers across Medicare, Medicaid, and Commercial lines of business, Optimity has identified 5 key steps to guide payers through their journey to expanding and scaling value-based contracting programs. Payers that carefully undertake this planning process are the most likely to realize the ultimate goal of linking cost and quality performance to payment, better serving members, and competing in a value-based world.
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Author: Vince Volpe
Vince Volpe, based in Optimity’s New York City office, has experience across the healthcare payer, provider, and managed care sector, including Medicare, Commercial health plans, Medicaid managed care, physician organizations, and health systems. His focus lies in engaging diverse organizations across the continuum to drive solutions for improving value in the healthcare system.
Vince has significant expertise in value-based contracting, population health, care management, and consumer/patient engagement. He has led the design and execution of numerous value-based care initiatives including the formation and launch of a multi-payer ACO, assessment of value-based contracting strategies for Medicaid MCOs, readiness support for a behavioral health and substance abuse IPA preparing for state-driven DSRIP value-based contracting initiatives, and future-state operating model design and road mapping of value-based contracting capabilities for a national managed care organization. Vince is a graduate of the Health and Pharmaceutical Management program at Columbia Business School, where he received his MBA.