3rd Annual Value-Based Network and Contract Management Summit

The shift to value-based payments across the U.S. has been patchy, with some regions moving faster than others. Market competition, level of clinical integration among providers, and a supportive infrastructure are some variables that affect providers’ willingness to embrace the model and their likelihood of succeeding in risk-based contracts.

• Identify indicators that exemplify a provider’s potential readiness to move to full risk and the next generation of accountable care
• Develop a customized approach to enable and transition providers to full risk when they are ready
• Discuss how consolidation, acquisition, and integration trends in a market can become leading examples of what change is possible
• Leverage a national shared savings model to give a consistent look and feel to value-based contracting

Providers and commercial payers should approach new payment models collaboratively, with an understanding of each other’s goals and a unique value proposition for the health plan, the providers, the patients, and members. In contracting, each organization must develop an appreciation of the other’s capabilities and strategic goals to determine the potential for alignment, mutual growth, and success.

• Hear strategies to identify payer or provider partners that align with your organizational focus and marketplace
• Develop a value proposition for health plans, providers, members, and patients
• Build flexible, long-term relationships that increase quality, reduce costs, and enhance the patient experience

As employers and patients seek greater value for each health care dollar, payers are responding with narrow network products. Narrow networks encourage members to choose the most efficient and effective providers with financial incentives such as lower co-pays.

• Discuss the structure required for effective payer-provider collaboration at a system level
• Understand how to implement an innovative care model focused on quality through well-designed market coverage
• Reconcile actual performance with reported performance to meet specifications in value-based contracts
• Analyze employer and consumer acceptance to narrow network design including concerns about limited choice

Research and experience have indicated that high Value Provider Networks are an asset for health plans and their customers. Savvy health plans know that in order to leverage this asset, they must establish strong relationships and remove unnecessary hurdles in their provider network and contract management processes.

• Uncover the significant pain-points during the contracting process and how to best address them
• Identify the tools and best practices that successful network managers utilize to maximize success
• Discuss the role technology plays in optimizing the end-to-end processes so health plans can develop, manage and leverage their relationships
• Explore the next big thing in provider network and contract management

In this case study, hear how one health plan prepares its primary care base to shift successfully to value-based care. Understand the commitment and resources invested over several years to support practice transformation from loosely-affiliated to clinically-integrated networks with protocols that support value-based payment, including the introduction of clinical transformation consultants.

• Hear a partnership approach to ensure the success of new payments models
• Brainstorm with physicians to understand practice needs
• Provide practices with the right data and tools
• Understand the benefits and challenges of implementing a population health management tool for providers
• Give physicians the same 360-degree view of patients as the health plan
• Discuss challenges and progress to-date
• Understand how the plan might redesign its program based on current assessment and feedback

Bundled payments are an important payment reform model under the ACA. The Medicare bundled care initiative has generated widespread interest among providers and commercial payers to create bundled payment arrangements with specialty providers. Most bundling models focus on orthopedic or cardiovascular procedures, rather than on episodes of care like cancer. This case study explores oncology bundles that help manage high spend and variation in care delivery common in treating this disease.

• Discuss the attributes of an oncology bundle that can lead to better management of cancer care and its related drug costs which typically represent a significant portion of plan spending
• Hear about a commercially-led oncology care bundle payment pilot underway
• Develop an understanding of Medicare’s oncology care model design to reduce hospital and pharmacy costs

Interest in private exchanges continues to grow and today there are dozens of private exchanges in operation. One of the key advantages of participating in a private exchange is access to more choice, yet many questions remain as to whether they can actually help consumers make better health decisions.

• Explore ways to increase choice without overwhelming consumers
• Discuss the implementation and evolution of decision support tools
• Hear a long-term outlook for private exchanges