Today’s Technology Must Support the Move to More Advanced VBC Payment Models

Alternative payment models (APMs) impose shared risk among payers, providers, and partners, incentivizing better clinical and financial performance. These models are at the heart of value-based care (VBC) initiatives, replacing the outdated and misaligned incentive system from fee-for-service models to provide more care, without accountability for whether that care leads to better outcomes for the patient.

But moving to more advanced alternative payment models doesn’t happen overnight. Payer organizations interested in participating in partial or full capitation, or prospective bundled payments, need technology that can support all stages of the transition. Most organizations begin with the simpler models that minimize financial risk exposure, such as primary care attribution, then move along the continuum to the most advanced (capitation).

Unfortunately, there are few technology platforms that can support the entire continuum of progressive risk-based APMs. That can lead to frustration as organizations try to put together a patchwork of tech solutions, programming interfaces, and short-term options to process payment, or face the daunting prospect of integrating new software as they advance to progressively more complex payment models.

Cedar Gate is different. We offer the only end-to-end platform that supports any payer organization in any risk-based payment model or line of business. Our tech was specifically designed for value-based care, which means we can help with everything from upside-only models to full and partial capitation.

RISK SHARING AS A STRATEGIC ADVANTAGE FOR PAYERS

The prevalence of risk-sharing arrangements is only increasing for both CMS and commercial payers. Collaborating with provider partners in these value-based agreements could be a strategic advantage for payers, especially in light of recent contentious negotiations between payers and provider networks across the country.

To better engage with providers – who are now being asked to successfully manage downside risk – payers need analytics tools that provide the right data to every participant. That includes:

• Clinical performance measurement based on the quality metrics used in the specific VBC models
• Financial performance analysis that forecasts target attainment and helps isolate specific actions that will impact the performance year
• Performance reports that bring transparency and focus to the metrics and populations that represent the greatest quality and revenue opportunity for providers

Cedar Gate’s unique approach to data management is at the heart of our ability to help payers better engage with providers as they move from fee-for-service to progressively more complex APMs. We can ingest more than 40 data types, including clinical and claims data, and have experience onboarding with hundreds of data vendors. Once ingested, Cedar Gate augments the data with multiple enrichments, such as risk scores, quality metrics, and social determinants of health.

The resulting data is more than 10 times the size of the original dataset, and provides a powerful foundation for large payer organizations to:

• Conduct funds flow analysis and identify insights to improve efficiency and performance over the course of a value-based contract
• View and report on performance in near-real time with customizable dashboards, a comprehensive library or reports, and automated reporting tools
• Forecast and model performance in various alternative payment models to identify the most promising opportunities
• Successfully negotiate clinical and financial targets before entering new risk-based contracts
• Build confidence within the organization, and with provider partners, by providing actionable data to understand which actions will have the greatest impact on performance

Feel prepared for the risk-based future that is already here – and the changes that are still to come – with the right technology to administer alternative payment models today and well into a value-based care future. Request a demo of our end-to-end platform today.