Scaling Value-Based Contracting Programs
by Vince Volpe
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.