02 — Capability · BC-1860.30
Value-Based Care Contracts
Succeed under contracts that pay for outcomes and total cost of care rather than volume, by modeling them before signing, tracking performance against benchmarks during the year and reconciling shared savings or losses. Negotiating fee-for-service rates is payer contracting.
- VBC
- Value-Based Contracting
- Alternative Payment Models
- ACO Operations
In scope
- Contract modeling and benchmark analysis
- Performance tracking against cost and quality targets
- Shared savings and loss reconciliation and distribution
- Risk adjustment documentation completeness
Out of scope
- Fee-for-service payer contract negotiation (see BC-1840.60)
- Quality measure submission to programs (see BC-1850.10)
- Assigning diagnosis codes to each encounter (see BC-1840.20)
- Submitting risk adjustment data as a health plan (see BC-1870.70)
Realized by · 4
- Epic · Healthy Planetstrong via BC-1860.30.20
- Oracle Health · Health Data Intelligencestrong via BC-1860.30.20
- InterSystems HealthShare · Health Insightpartial via BC-1860.30.20
- HealthEdge · Revenue Align Edgepartial via BC-1860.30.40
Used in · 2
Build it · 0
- Nothing in the library points here yet.
Decomposes into · 4
- BC-1860.30.10Value-Based Contract ModelingModel the financial and quality terms of proposed value-based contracts against the attributed population before the organization signs.
- BC-1860.30.20Value-Based Performance TrackingTrack cost, utilization and quality against each contract's targets during the year, and show leaders and practices where to act.
- BC-1860.30.30Shared Savings SettlementCalculate or reconcile shared savings and losses at settlement, whether the organization is the paying plan or the participating provider, dispute differences, and distribute earned amounts to participating clinicians.
- BC-1860.30.40Risk Adjustment AccuracyMake sure each person's documented conditions are complete and supported, so risk-adjusted payments and benchmarks are right.