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Analytics Tools to Model VBC Contracts Help Minimize Risk

BLOG | June 23, 2023

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A value-based care (VBC) future is on the horizon for everyone in healthcare. It’s not easy to move from a fee-for-service (FFS) world to the alternative payment models (APMs) and collaborative care delivery networks. But this healthcare future offers the chance for better quality care at a lower cost for patients.

Part of the challenge in making the switch is the significant financial investments (and more financial risk) organizations must take on in VBC. In upside-only or shared savings arrangements, healthcare providers and staff members must engage in a lot of new activities that aren’t reimbursed in fee-for-service. That includes things like evaluating social determinants of health, bringing in patients for wellness and preventive visits, optimizing care transitions, and proactively managing chronic health conditions. Those activities are also part of downside-risk programs, which put organizations at risk of financial losses if they can’t meet VBC goals.

Organizations about to enter into these VBC contracts are understandably uncertain about the future.

  • Will you be able to achieve the quality metrics?
  • How much risk is in your current patient population?
  • Are you likely to hit your financial goals in downside-risk models?
  • Who should you include in your ACO provider network?
  • Would advanced alternative payment models (AAPMs) like prospective bundles or capitation be financially viable and advantageous?

In a world where time and resources are limited, the Cedar Gate Value-Based Care Analytics (VBCA) can help in the contract modeling and design process with software tools that provide the answers you need before you sign a VBC contract.

ANALYTICS HOLD THE KEY TO VBC SUCCESS

The first step to minimizing risk and figuring out the optimal value-based care contract for your patient population and healthcare organization is the right data. The next step is having analytics software that will translate that data into meaningful and actionable insights.

Cedar Gate’s VBCA software is designed specifically with the tools that make the entire contracting process easier. Users can test how various payment models will play out given your current patient mix, and input information for various contract terms. The analytics tools will forecast performance under multiple models and with different contract terms so you can enter negotiations and structure a contract with the best chance for success.

These tools include:

Bundle Modeling: A self-service workbench for defining and creating custom bundled payments. The software leverages bundles definitions from our extensive Bundles Library, providing you with tools to:

  • Inform, prioritize, and select bundle procedures with the greatest opportunity for success.
  • Create, model, and customize retrospective and prospective bundle payment programs with any contract specifications you want to include.

Actuarial Modeling Module: A financial analytics tool for contract design and administration, forecasting performance to calculate terms for prospective population-based contracts. This module:

  • Facilitates custom risk model construction, target calculations, and payment reconciliation with transparent documentation.
  • Allows modeling for target prices, claims, and risk attributes based on specific claims’ definitions, outlier thresholds, and claim inclusion/exclusion modelers.
  • Provides detailed reconciliation and performance reports with target price adjustments, claims summaries, and contractual risk attributes.

AVOID SURPRISES WITH ADVANCED SIMULATIONS

With the Cedar Gate Value-Based Care Analytics platform, users construct, measure, and simulate expected results for providers across various value-based contract types. The software combines historical performance data with information on the type of VBC contract you are considering to predict future results. Organizations can determine with a high degree of confidence how each provider would have performed under the contract terms – and how they might perform in the future.

The analytics software can reveal insights on how providers could improve performance in a value-based care future using what-if scenarios. It can also dynamically model different risk arrangements, such as shared savings with corridors, to identify optimal contract parameters. These advanced analytics and automated processes save time and money, empowering your organization to confidently engage in value-based contracts.

Don’t let the complexities of contract modeling and design hold you back from embarking on a VBC journey to improve care quality and lower healthcare costs. Explore the potential of Cedar Gate Value-Based Care Analytics today.

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