I’d like to share a core memory from my time as a leader of a value-based care contracting analytics team; a story about a failure that inspired the launch of Syntax:
Imagine a conference room filled with people. On one side, me and peers from my organization including our (defensive-looking) networking contracting team and on the other, a (defeated-looking) physician leadership team:
“You haven’t set us up to win,” said Dr. Samson, the physician leader, his statement hanging, suspended in the room. Dr. Samson’s practice had entered a shared risk arrangement with my health plan, with the intention of creating better patient quality outcomes and lowering medical costs so that they would have a share in the financial gain from cost savings my plan achieved. Yet, my team and I were there to deliver the news that not only would their practice not receive a payout this year, but also that because of the terms of our shared-risk arrangement, they would be carrying a negative balance into the next performance cycle – essentially starting from behind. Our team had spent weeks carefully preparing analyses that defended our position and showed how Dr. Samson’s group had missed the mark. But, at this moment, none of that mattered. They had lost confidence in our program, and it would be an uphill battle to keep them on board.
Sadly, tense meetings like this are all too common in VBC today. Network managers find themselves in constant damage control trying to manage provider abrasion from missed performance targets. Providers are frustrated with not knowing if they are on track to see financial gains from their VBC contracts, often learning that they missed targets after it’s too late to course correct. As a result, both sides experience delays, have distrust over the data, and are disillusioned with the prospects of future success.
There is a better way.
I believe better VBC requires tools and automation that :
help build a culture of symmetry, trust, and transformation;
get baseline contract assumptions right; and
take the friction out of the reconciliation process.
Build a culture of symmetry, trust, and transparency in value-based care
When I reflect on the story above, I’m struck by the “us vs. them” tenor. These individuals weren’t territorial, but their one-sided tools and outdated processes created the perception of territorial behavior. Culture is complex, but in order for teams to truly collaborate, they must have the data, tools, and automation that enable collaboration. That’s one reason why industry groups have created tools like this Roadmap for Driving High Performance - Data Collection Tool from HCP-LAN.
Syntax’s two-sided platform enables collaboration and more: users interactively negotiate value-based contracts, share proposed terms and associated financial estimates directly, and review counter-proposals all within one platform. It allows all parties to make confident decisions knowing what their contract really means and what it will take to be successful.
Many organizations are doubling down on payer and provider engagement and fostering relationships to win in the market. But relationship building alone will not drive change. I believe organizations that win in VBC will do so because they adopt tools and automation that enable a culture of symmetry, trust, and transparency–within their own organization and with their payer/provider partners.
Get baseline assumptions right
I often hear that VBC negotiating teams don’t have a shared understanding of key terms and baseline assumptions. Teams aren’t speaking the same language: providers struggle to translate their care goals into payer terms, and payers struggle to translate performance goals into clinically actionable terms. Also, data is critical to get assumptions right–data from payers and providers, plus supplemental market cost and quality data. As one physician leader said, “no data, no deal.” But getting and integrating the right data is no small task, prompting numerous reports to help parties overcome challenges associated with data sharing, such as this report from AHIP/AMA/NAACOS, outlining best practices to advance data sharing.
Syntax is leading a new approach: delivering insights for best-fit model design and providing payers and providers with the actionable information they need to work together. In the Syntax platform, all stakeholders are able to see, in real time, the impact of quality or cost term changes directly in the platform and can answer questions about attribution or cost terms, ensuring alignment on expectations.
With Syntax, everyone–healthcare actuaries, network managers, analysts, and providers–work with a common data set to:
compare savings, revenue, quality metrics and trends;
model contract scenarios by rapidly understanding affinity (provider panel experience) and configuring attribution (plan assignment rules); and
design incentive terms using contract templates or building them on demand
Syntax has also partnered with CareJourney, the leader in provider cost and quality data, to offer users access to comprehensive and reliable market data. This, combined with Syntax’s advanced modeling tools, allows payers and providers to solve for the unknown, de-risking clinical and financial outcomes.
Teams must have access to shared data and shared understanding of key terms and assumptions for VBC to work.
Take the friction out of reconciliation
It’s no wonder that, with poor design upstream, reconciliation of VBC performance can create friction for everyone. Our critical knowledge workers–network, analytics, and actuarial teams–need to feel rewarded and valued, not burnt out. As outlined by Shaun Garcia, Chief Quality Officer at Brevard Health Alliance and Syntax client, VBC teams need frequent visibility to actual performance vs. targets and sound actuarial support to accurately assess and manage risk.
The Syntax platform enables teams to understand and monitor performance in real time. Plan and provider leaders are able to focus on achieving the objectives of value-based care–improving outcomes and reducing costs–rather than a cumbersome reconciliation process. What’s more, Syntax provides the ability to refresh performance measurement in real time, allowing team members to preview emerging trends for course correction and value alignment before it’s too late.
I believe that teams need infrastructure, tools and automation to remove friction from the reconciliation process, allowing them to focus administrative time on replicating success instead.
An ounce of prevention
Benjamin Franklin famously advised fire-threatened Philadelphians in 1736 that, “An ounce of prevention is worth a pound of cure.” Clearly, preventing fires is better than fighting them. With better tools and planning, my team could have protected ourselves from this disaster of a meeting and protected Dr. Samson’s group from missing their incentive benchmarks. It’s experiences like this and Franklin’s concept of prevention that inspired Syntax Health.
Supporting culture transformation, getting baseline assumptions right, and taking the friction out of the process–these are just three of the many ways Syntax is helping to reimagine VBC. Our team has 60+ years of combined experience working for and with health plans, leading VBC contracting and analytics teams on both the vendor and supplier side and steering engineering efforts. Most importantly, we believe in the power of value-based care to transform healthcare by focusing on outcomes rather than volume.
Reach out today to join us in creating a better VBC blueprint.
Rachael Jones is the founder & CEO of Syntax Health and a thought-leader in Healthcare Payment Innovation, Analytics, Product Development, Commercialization & AI Solutions