Healthcare is undergoing a significant shift from a volume-based model to one focused on value. New cost of care
and reimbursement models mean organizations must think more strategically about their value-based contracts,
including their partners in risk sharing and overall performance. Effective financial success in the accountable care environment now hinges on providers’ ability to manage revenue and risk differently than they ever have before. The right insights and data are required to enable accountable care organizations (ACOs) and health systems to make the best decisions possible to secure effective reimbursement and remain competitive in an evolving landscape.
The MedInsight® Value-Based Care (VBC) Contracts application provides ACOs, health systems, and independent physician associations (IPAs) with a full view of their financial performance across different types of VBC agreements. Interactive dashboards enable users to accurately model the potential success of each contract, set individual targets, and monitor their progress over time. With VBC Contracts, your organization can benefit from the following capabilities to monitor revenue and manage risk:
Maximize profitability
Gain insight into your organization’s financial health and identify areas to increase revenue generation with a clearer understanding of total assigned beneficiaries, revenue, and overall service leakage.
Rock-Solid Data Confidence
Leverage a reliable and accurate application that draws from trusted Milliman methodologies and extensive experience in loading Medicare CCLF data feeds, as well as commercial/Medicaid data feeds.
Holistic Population Views
Modify care management strategies and interventions based on the history and characteristics of at-risk populations, including membership, risk score, and claims by Medicare Eligibility Category (MEG).
Comprehensive Cost Projections
Calculate the projected performance of settlements over multiple performance years (historical and current) and compare the revenue from fee-for-service models with value-based models to evaluate the move towards value-based healthcare.
Interactive Cost Modeling
Analyze potential cost-reduction strategies and model various scenarios to determine how modifications to their approach could affect revenue from commercial, Medicare Advantage, Medicare fee-for-service (FFS), and Medicaid risk contracts.
VBC Contracts in action
Contracts dashboards
Improve contract and cost Management
Gain a centralized view of all total cost of care (TCOC) value-based contracts for ACOs and take your analysis to the next level by comparing performance at the risk unit level. Whether it’s a provider group, region, TIN, or any other risk unit, Milliman’s robust actuarial methodology empowers your organizations to project savings or losses for the current performance year and identify additional opportunities for optimization.
Optimize efficiencies and outcomes
Leverage a single source of truth that aligns payer and provider data and eliminates manual modeling. Access
multiple years’ worth of data effortlessly, allowing your organization to analyze trends, identify areas for improvement and make data-driven decisions. Stay ahead of the curve with timely data refreshes with provides monthly updates instead of the standard quarterly updates from CMS.
Increase performance and profitability
Access a wealth of historical data to make informed decisions that optimize your overall performance. Create projection scenarios and explore potential savings or losses for the current performance year. With comprehensive insights, you can make strategic decisions to maximize your financial outcomes.
Use cases: How VBC Contracts can help
FFS reimbursements
Track and analyze payments received through the traditional FFS model and evaluate the financial performance tied to this payment method.
Financial planning
Anticipate future cash flows of value-based care contracts to aid in proper budgeting and resource allocation.
Alternative payment contracts
Manage alternative payment contracts, project potential revenue streams, and assess the impact of quality metrics on the financial outcomes.
Value-based care resources
How digital transformation drives value-based care
As the transition to value-based care continues to accelerate, health plans are driven to deliver value-centric services through digital transformation. This can facilitate a more connected ecosystem for building greater transparency, trust, and interoperability. In this ebook, learn about how digital transformation can be beneficial for value-based care and how MedInsight can help you with … How digital transformation drives value-based care
2024 Outlook: Five key analytic capabilities shaping VBC
The healthcare industry is undergoing a transformation, largely driven by value-based care (VBC), artificial intelligence (AI), and digital transformation. These trends, which gained significant momentum in 2023, will continue to shape the healthcare industry in 2024 and beyond. As organizations aim to improve efficiencies and the delivery of care, the increasing use of analytics emerges … 2024 Outlook: Five key analytic capabilities shaping VBC
Leading the way in value-based care: Best practices for mitigating risk
The healthcare landscape is rapidly evolving to one in which value and accountable care are the predominant measures for delivering high-quality, affordable care. It is an evolution that has been underway for more than a decade, but recent years – and the demands of an aging population – have brought transformation at a rapidly growing … Leading the way in value-based care: Best practices for mitigating risk
Bundles
The MedInsight Bundles application offers organizations participating in bundled payment programs the insights they need to efficiently manage the payment models implemented by the Center for Medicare and Medicaid Innovation (CMMI).
VBC Platform
The MedInsight® VBC Platform is designed to support Accountable Care Organizations (ACOs) focusing on VBC by delivering the insights you need, when you need them.
VBC Insights
With VBC Insights, included in MedInsight’s Value-Based Care Platform, users can effortlessly track utilization trends over time and dive into individual patient cohorts to uncover cost-saving opportunities.
The right data for every model of value-based care contracting
How MedInsight Supports Organizations on the Glide Path to Risk For healthcare provider organizations navigating the array of alternative payment models in use across all phases of value-based care contracting, the complexity can be daunting. From small physician groups operating on a largely fee-for-service basis to health plans managing the claims of tens of thousands … The right data for every model of value-based care contracting
Reducing risk to drive VBC success for ACOs
As value-base care (VBC) progresses, accountable care organizations (ACOs) face a significant challenge in balancing the quality of care and financial outcomes while taking on increasing financial risk. This task becomes even more difficult without a comprehensive understanding of patient populations and overall performance, making it challenging to sustain value-based care effectively. ACOs typically have … Reducing risk to drive VBC success for ACOs
Reporting Framework for Value Based Care
As the cost of healthcare continues to rise, both payers and providers continue the “triple aim” of delivering effective quality care while managing their costs. Value based care (VBC), or value based reimbursements, has emerged as an effective mechanism for achieving this goal. In fact, based on estimates developed by National Business Group on Health, … Reporting Framework for Value Based Care
Relevant resources
How digital transformation drives value-based care
As the transition to value-based care continues to accelerate, health plans are driven to deliver value-centric services through digital transformation. This can facilitate a more connected ecosystem for building greater transparency, trust, and interoperability. In this ebook, learn about how digital transformation can be beneficial for value-based care and how MedInsight can help you with … How digital transformation drives value-based care
2024 Outlook: Five key analytic capabilities shaping VBC
The healthcare industry is undergoing a transformation, largely driven by value-based care (VBC), artificial intelligence (AI), and digital transformation. These trends, which gained significant momentum in 2023, will continue to shape the healthcare industry in 2024 and beyond. As organizations aim to improve efficiencies and the delivery of care, the increasing use of analytics emerges … 2024 Outlook: Five key analytic capabilities shaping VBC
Leading the way in value-based care: Best practices for mitigating risk
The healthcare landscape is rapidly evolving to one in which value and accountable care are the predominant measures for delivering high-quality, affordable care. It is an evolution that has been underway for more than a decade, but recent years – and the demands of an aging population – have brought transformation at a rapidly growing … Leading the way in value-based care: Best practices for mitigating risk
The right data for every model of value-based care contracting
How MedInsight Supports Organizations on the Glide Path to Risk For healthcare provider organizations navigating the array of alternative payment models in use across all phases of value-based care contracting, the complexity can be daunting. From small physician groups operating on a largely fee-for-service basis to health plans managing the claims of tens of thousands … The right data for every model of value-based care contracting
Reducing risk to drive VBC success for ACOs
As value-base care (VBC) progresses, accountable care organizations (ACOs) face a significant challenge in balancing the quality of care and financial outcomes while taking on increasing financial risk. This task becomes even more difficult without a comprehensive understanding of patient populations and overall performance, making it challenging to sustain value-based care effectively. ACOs typically have … Reducing risk to drive VBC success for ACOs
Reporting Framework for Value Based Care
As the cost of healthcare continues to rise, both payers and providers continue the “triple aim” of delivering effective quality care while managing their costs. Value based care (VBC), or value based reimbursements, has emerged as an effective mechanism for achieving this goal. In fact, based on estimates developed by National Business Group on Health, … Reporting Framework for Value Based Care