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In a Time When Everyone Is Rushing to Value-Based Care, It’s What You Don’t Know That Matters

Updated: Mar 18


woman contemplating while using laptop for work

“It’s not what you know, it’s who you know” is a common refrain in business circles that espouses the value of a well connected network. While this might be true for getting that warm introduction or advancing to the next level of professional success, in a time when it seems everyone is rushing to value-based care (VBC), I propose that it’s less about who and more about what.


Regardless of what side of the VBC equation you are on: provider or plan, when considering alternative payment models there are important questions you, as a healthcare leader, should be able to answer about your VBC program as it relates to your business performance.


In fact, if you are feeling uneasy about your value-based care strategy and the status of your current program, it’s likely because you don’t know the answer to these questions and therefore lack confidence in your organization's ability to achieve its VBC goals.


I’ve led Payment Innovation Analytics teams at the largest National Blue plan and the largest Medicaid plan in the NYC Metro area. Because of that lived experience, I have seen firsthand the challenges provider and payer organizations grapple with in negotiating risk-based agreements. Keep reading below for the three most important things to know about your VBC program as it relates to your business performance.



two people negotiating with documents

Do you know #1: Do you know the cost of delayed negotiations?


On average, it can take anywhere from 12 to 15 months to negotiate a risk-based contract, it’s no surprise that over 85% of health plans cite inefficient contract modeling as their biggest barrier to adoption. When was the last time your organization measured the time it takes to get a contract over the finish line? As a healthcare leader, have you ever considered the opportunity cost of contract negotiations that resemble the title of that infamous Barney song, you know, the one that never ends? Here’s a short list:

  • The internal cost of meetings hashing and rehashing contract models, tracking multiple contract version changes and measuring the impact of tweaks to assumptions.

  • The external cost of fractured trust and abrasion from cumbersome back-and-forth toiling over attribution counts or cost trends.

  • The existential cost of delayed alignment on what constitutes high value patient care, which is ultimately the point of VBC in the first place.

What if you could get your next contract done in half the time? How would your business results improve with a complete reimagining of how your organization models and negotiates value based contracts?



contract document

Do you know #2: Do you know that your VBC contracts are the best fit design?


It’s commonly overlooked that value-based care is both a clinical approach that focuses on preventative services and long-term health care outcomes and a payment model that enables the appropriate incentive alignment to achieve those clinical goals. Value-based models are not one-size-fits-all yet so many organizations make the mistake of treating them that way. Is your organization guilty of this?


According to the HCP-LAN 2022 APM Measurement Effort, more than half of organizations are still in the beginning or midway through their transition to value-based care, a decade after the ACA first promoted this accountability approach. This isn’t surprising considering how many versions of payment models exist. With so many flavors to choose from, how do you know which model is best for you?


What’s needed is more solutions that facilitate alignment and confidence in the math, shared transparency with regard to data and contract parameters and financial incentives that acknowledge the barriers to entry for small physician group practices and healthcare providers with less capital, who tend to care for underserved communities.



two people holding puzzles pieces next to one another

Do you know #3: Do you know if your organization is viewed as a strategic partner?


If you’ve been a healthcare leader long enough, you’ve come accustomed to a headline-grabbing news story like this one every few months or so regaling another payer-provider system contract negotiation gone south. Payor-provider contracts have driven fee for service rates through the roof, and that’s been a major driver of why our nation’s healthcare costs have skyrocketed to nearly 20% of GDP without a commensurate rise in clinical outcomes and patient experience.


The push towards value-based care is really a push to align value creation with value capture. And that’s really where risk-based contracts come in. They are a reimbursement mechanism that aligns incentives. True alignment however, requires a shift in mindset that acknowledges VBC as a team sport - a strategic partnership where both sides can have informed conversations about tactics that expand the pie vs. fighting over who gets the bigger slice.


Here’s a few ways to signal if your organization is fighting for a slice instead of being viewed as a strategic partner:

  • You’re constantly battling over patient attribution.

  • You’re on version “final.revised4.newfinal.xls” of a contract model and no closer to agreement than when you started.

  • The measurement period for your shared savings is ending in the next quarter and you’re not sure if there’s a possibility of payout.

  • Emails between organizations typically have no less than seven executive leaders “cc’d”

It’s clear the VBC train is going to keep on moving. As a healthcare leader, you have an opportunity to get on board or you may find your organization left behind. It’s time to turn stakeholders into teammates and make value-based care work for everyone involved.


Help your organizations get “in the know” by:

  • Exploring contracting systems that promote efficiency across organizational silos and save time.

  • Identifying the most favorable incentive designs aligned with your business strategies.

  • Facilitating frictionless collaboration that fosters strategic partnerships.


We can help your organization bridge the gap between knowing and not knowing so that ultimately, you, me and everyone can get the best health outcomes possible through aligned incentives and better care.


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