In its November 2017 issue, Accountable Care News asked four industry thought leaders for their responses to the question “What are the most effective strategies for achieving value-based reimbursement?” Evolent Health’s Medicare ACO Solutions President Frazer Buntin’s response appeared in the publication’s “Thought Leaders’ Corner.” His response is below:
Beyond the clinical strategies, technology, analytics, physician engagement and care coordination typically discussed, there are essentials of business infrastructure that enable success:
- An over-arching essential is to establish a separate business unit. Value-based care is difficult and very different from fee-for-service. Borrowing time from existing staff with day jobs will not give the value opportunity what it needs for success. Establish a business unit that is dedicated to achieving clear objectives for value-based care.
- It’s essential to operate each value-based care opportunity as its own P&L. For a Medicare ACO, there should be a clear annual revenue target for shared savings, budgeted costs to achieve those savings (staff, technology) and a profit target. Apply the same structure to a value contract with a commercial or Medicare Advantage payer, employee population or owned health plan. The leader of the value business unit should be held accountable for the P&L of each opportunity and the total department P&L.
- Each opportunity should have a specific plan for how to achieve the reduction in medical expenses. It’s not sufficient to simply state, “We’re going to save 3 percent in medical expenses.” You need to know on day one how much of the savings will come from care management, inpatient, outpatient, post-acute, imaging and specialists. Having a detailed plan with a savings allocation is critical.
- Specific owners of each category should be held accountable on a weekly and monthly basis for executing and reporting on progress.