Skip to content

Lower Risk and Reward with Sub-Capitation

THE VBP Blog One of the greatest areas of concern when we discuss capitation, is that it is “all or nothing.” However, that is not the case. In the development of Value Based Payments, there are ample opportunities to incorporate partial capitation, for specific services, events/episodes, and even treatments. As value-based options continue to take on more risk, we find ourselves looking at every alternative option. Capitation, as we covered in the last blog, has many potential positives for the consumer, physician, and managed care organizations (MCO). Full capitation can be a hard sell for some doctors as they want some flexibility as they create innovative ways to treat patients. That lands us squarely on sub capitation (aka partial capitation)… Read More »Lower Risk and Reward with Sub-Capitation

VBP Risk Capitation Pros and Cons

Break Through Value Based Payments Part 10: Risk Capitation Pros and Cons THE VBP Blog Welcome back to THE VBP Blog Series. Continuing our drill-down into risk-sharing in Value Based Payments, in today’s blog we look at the capitation model. As the ever-challenging task of lowering healthcare costs continues to come to the forefront, organizations may look to capitation, which requires that providers take on the full financial risk for the care of their consumers.   Do keep reading! It’s already shown success in California, where the state’s Regional Health Care Cost & Quality Atlas reveals the capitated-integrated model delivers on all the major VBP scores:  9% lower total cost of care, 14 points higher in quality, and $4,450 less in total cost of care… Read More »VBP Risk Capitation Pros and Cons

VBP Risk Sharing

Break Through Value Based Payments Risk Sharing in Value Based Payments The VBP Blog Welcome back to THE VBP Blog Series. As many of you have asked for continuing the global view of Value Based Payments, in today’s blog we look at how contracting entities take part in risk sharing arrangements. This is usually an option for mature VBP organizations, with proven stable data tracks and clear quality-controlled processes. Risk sharing involves actually foregoing revenues if goals are not accomplished. It should not be approached lightly. Caption for Photo Risk Sharing and Reward A shared risk value-based model representing possibly the best of both of those worlds. Thought of as the “next-level” of value payment methods, risk-sharing is the ultimate opportunity for… Read More »VBP Risk Sharing

elderly man thumbs up

Shared Savings in VBP

Break Through Value Based Payments Risk Capitation Pros and Cons The VBP Blog So, in preparing for our 8th installment of our blog series, it’s become evident that there’s a whole lot more than 10 portions of the topic to cover.  The progress through the Value Based Payments journey has many more steps and stepping stones than the initial view most of us have.  In the past two weeks, I had the opportunity to talk with a number of providers about an alternative payment structure and I found myself breaking down the process from alternative payments to shared savings into potentially 15 or more steps.  As you read on…. Consider our Advocate’s Perspective and join us in making sure that our consumers’… Read More »Shared Savings in VBP

nurse and patient in a wheelchair

Succeeding with Payment for Outcomes

Break Through Value Based Payments Succeeding with Payment for Outcomes The VBP Blog Value Based Payments are leading us to focus on the outcomes we can deliver and to have providers share in the savings.  However, the real success of payment for outcomes is in better health outcomes, longer periods without a need for higher-level care, and better quality of life for consumers.   The Advocate’s Perspective in this blog focuses on the latter part of this statement. Focusing on Patient Outcomes Value Based Payments are leading us to focus on the outcomes we can deliver and to have providers share in the savings.  However, the real success of payment for outcomes is in better health outcomes, longer periods without a… Read More »Succeeding with Payment for Outcomes

medical billing

VBP Bundled Payments

Break Through Value Based Payments Bundled Payments THE VBP Blog As we move Onward! Along the continuum of Value Based Payments, we examine Bundled Payments in this installment of our series. We have noted that some of these topics require more depth, so you may see our series expand to 12 or more…. This gives us the opportunity to share and advocate even more. Look for our Advocate Perspective below! Bundled payments are forecasted to account for 17% of payments by 2021, according to McKesson and ORC International. In the past two blogs, we have covered payment for process, alternative payment models, and payment for performance. All three of those set up building blocks for larger value-based payment changes. Bundled payments in… Read More »VBP Bundled Payments

Older couple sitting by water

VBP Payment for Performance

Break Through Value Based Payments Payment for Performance THE VBP Blog We have received very positive response to this series and we continue to see the path of Value Based Payments as a progression, a journey from knowing what you do, how you do it and how well you do it, to capitalizing on the quality of what you share in the value of what you are delivering.  Our Advocate’s Perspective is at the end of this blog… Make sure to check it out! The second step in the Value Based Continuum is Payment for Performance (P4P). Payment for performance takes the fee-for-service model and nudges it towards a value-based model. This is done by having metrics set and providers achieving, advancing, or exceeding… Read More »VBP Payment for Performance

VBP Payment for Process and Alternative Payments

Break Through Value Based Payments Payment for Process & Alternative Payments THE VBP Blog Welcome back.  Our blog rolls on as we start to dive in the Value Based Payment (VBP) Continuum. The first steps on the continuum are Payment for Process & Alternative Payments. As we monitor changes in healthcare and move closer to the integrated VBP model, this first step is crucial for organizations as they prepare for the future. Look for our Advocate’s Perspective at the close of this blog. Those of you who participated in our presentation heard us urge you to practice measurement, develop tracking and know what you do and how much it costs.  This skill set is one that is foundational to the ability  to demonstrate… Read More »VBP Payment for Process and Alternative Payments

Value Based Payments

VBP Payment for Value, Quality, and Outcomes

Break Through Value Based Payments Payment for Value, Quality, and Outcomes THE VBP Blog Happy New Year! We hope 2019 is healthy and successful for you and yours. This is the third blog in our series. We want to continue to share the facts with you and encourage you to consider our Advocate’s Perspective…. And to share it with your colleagues. The transition from the Pay-For-Volume to the Pay-For-Value model marks a major shift in healthcare policy. This is by no means a “light switch” that can be done with small modifications. Healthcare providers will be expected to offer value over volume, quality over quantity, and outcomes versus activity. Let’s take a look at some examples of each. Value vs. Volume… Read More »VBP Payment for Value, Quality, and Outcomes

Value based Payments

Value Based Payments… What does it really mean?

Break Through Value Based Payments Value Based Payments…What does it really mean? THE VBP Blog The adoption of value-based care is expected to account for 59% of all healthcare payments by 2020. Read that again. Now one more time. Let’s break down how we got here. We are proud to include an advocate’s perspective as part of this blog… Read On. Traditionally, payment for health services has run on a model called fee-for service (FFS). This simple model means that physicians and healthcare providers delivered in units. This has little to do with results or outcomes of those services. In 2017, the estimated cost of care for an insured family of four reached nearly $27,000 considering health insurance, payroll deductions, and out of pocket… Read More »Value Based Payments… What does it really mean?