In the rapidly evolving healthcare landscape, value-based care (VBC) agreements have become essential for aligning incentives between providers and payers. However, signing a contract is just the beginning. The real challenge lies in operationalizing these agreements effectively. Read more on how to do this well.

Key Takeaways

1. Preparation is Critical: Success begins in the months leading up to implementation. Aligning provider expectations with payers prevents missteps and delays.
2. Communication Drives Success: Frequent provider engagement with health plans helps providers stay ahead of challenges and demonstrate progress.
3. Actuarial Analytics Matter: Proactively tracking key performance indicators builds credibility with payers and sustains long-term partnerships.

Laying the Foundation for VBC Success before Go-Live

Success begins well before the agreement goes into effect. Setting clear expectations between the provider and the payer is essential. Aligning on the pace of patient engagement, operational maturity, and data-sharing mechanisms helps prevent misunderstandings down the line.

Coordinating with stakeholders within the payer organization is equally important. Providers should ensure that the payer's Member Services teams understand their role in the network and can confidently answer patient inquiries.

Common Challenges in Pre-Implementation

Misalignment on Patient Attribution and Engagement

A frequent pain point in VBC contracts is unclear expectations around patient engagement. Providers and payers must align on enrollment targets, engagement levels, and attribution methodology.

Attribution becomes particularly complex when multiple value-based programs overlap. In these situations, "You end up having to carve out patients already attributed to a full-risk primary care group and make them ineligible for another model that might be clinically beneficial," Fennel noted during the webinar. Addressing these challenges upfront prevents conflicts later.

Navigating Complex Health Plan Processes

Health plans often operate on legacy data infrastructure, making performance assessment difficult. Additionally, actuarial teams supporting VBC arrangements are often stretched thin given a high volume of requests from VBC stakeholders, such as finance, contracting, business development, and clinical teams and the need to call upon a variety of analytical knowledge in different areas such as trend dynamics, case impact assessment, benchmarking, forecasting, reserve implications, risk adjustment, contract modeling, codeset mapping, etc. to satisfy the analytical needs of VBC arrangements.

Providers should take ownership of their analytics rather than waiting for health plans. By proactively presenting data and learnings, providers demonstrate credibility and strengthen partnerships with payers over time.

Pre-Implementation Checklist

Before your VBC agreement goes live, ensure you've addressed these critical areas:

1. Clarify attribution methodology and patient engagement expectations
2. Establish data sharing protocols with the health plan
3. Align on key performance metrics and reporting cadence
4. Brief internal stakeholders on operational requirements
5. Connect with payer counterparts beyond the contracting team

Taking these steps before implementation creates a solid foundation for long-term success in value-based care partnerships.

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This is part 1 of our Value-Based Care Success series. In our next post, we'll explore "The First 90 Days: Critical Success Factors for Value-Based Care Implementation."

Are you a healthcare organization involved in risk-bearing or VBC arrangements?
Connect with Frank at hello@accorded.com to learn how Accorded's tech-enabled actuarial products and services can help you optimize for success, or contact Eric at eric@valuestrategies.health to learn more about Value Strategies, LLC.

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