What are the most effective strategies for achieving value-based reimbursement?
Posted on Nov 20, 2017

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:

  1. 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.
  2. 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.
  3. 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.
  4. Specific owners of each category should be held accountable on a weekly and monthly basis for executing and reporting on progress.