4 tips to land a value-based contract in your medical practice
Value-based contracts offer many potential benefits, including the ability to reduce uncompensated time as well as improve the financial state of your medical practice. And if you’re thinking about venturing into the brave new world of value-based care, you’ll need to know how to land one of these contracts. As with any payer agreement, it all comes down to the art of negotiation. Consider the following tips to help you land a successful value-based contract.
1. Know what types of value-based contracts your payer offers. For example, options might include a pay-for-performance contract, shared savings contract, capitation model, or episodic payment model. If your payer offers more than one of these options, choose the one that best aligns with your clinical and financial goals. Base your decision on the type of care you deliver, the market in which you reside, your patient population, and other factors. What are you passionate about and what patients do you think you can help the most?
One important question: How does you payer attribute patients for purposes of performance evaluation? Attributed patients are those patients (and their associated costs) for whom you’ll be held accountable. Do you have the capacity to take care of patients attributed to you? Does it make sense to pursue a value-based contract, or should you stick with fee-for-service for now?
2. Make your case. What makes you well-positioned to deliver value-based care? For example, what are your patient outcomes? What about patient satisfaction scores? What are your strengths, and what differentiates you from competitors? In essence, why should the payer engage in a value-based contract with your medical practice?
3. What will you do differently to promote value-based care? For example, if you land a value-based contract, do you plan to extend your office hours? Hire care coordinators? Ramp up efforts to address social determinants of health? Switch electronic health records (EHR) to enable better data sharing? Payers want to know about the operational changes you’ll make to support value-based care workflows.
4. Promote your data and technology capabilities. What type of data do you already collect and in what format, and how might this data benefit the payer? Do you know which patients tend to have the highest risk and the highest costs in your medical practice? If not, you may need to conduct a comprehensive analysis of historical claims data, patient outcomes, and utilization patterns. What is your plan to improve outcomes and reduce costs for these patients and others?
Also, what are you doing to improve the quality of this data? Payers are very interested in this because they want and need a data partner. Quality data is also important to your medical practice because payers gauge performance on this data. If your data is filled with errors and omissions, you may miss out on financial incentives or even be financially liable, depending on the terms of your contract. You’ll need to ensure your data reflects the value-based care you provide.
In addition, what EHR technology do you use, and how does it support your participation in one or more value-based contracts? How does it maximize ease of data exchange, use, and accuracy? How do your EHR capabilities meet the data sharing and integration needs for a particular value-based care model?
Review the contract carefully before signing
Once you’ve got the value-based contract in front of you, take a close look (and perhaps consult with legal counsel) before signing. Though not specific to value-based contracts, the American Medical Association provides a checklist of key terms and considerations when reviewing a payor contract as well as questions for physicians to ask when reviewing, understanding, and negotiating agreements.
Looking ahead
As you consider pursuing one or more value-based contracts, it helps to think about what your medical practice brings to the table. When negotiating these contracts, focus on advocating for yourself and your patients. Leverage your data, technology, and the high-quality patient you provide. Learn how edgeMED can help.
