Commitment Statement:
• 2017 Goal – Ensure 25% of payments under Category 2 and Category 3
• 2018 Goal – Ensure 50% of payments under Category 3 and Category 4
The Analytics team completed full integration of the company’s data sources to more easily and accurately facilitate data sharing with key project stakeholders. Ultimately, progress and success will be measured based on the following:
1. % of participating providers in APMs
2. % of Dollar payments under APMs
3. # of Members paneled to Providers under APMs
5. # of Value-Based agreements
6. Geographical segmentations
To support this endeavor, the Analytics team, in collaboration with Provider Operations staff, is working on the creation of automated solutions to analyze clinical, financial and member experience data as a preemptive measure to address any potential deficiencies and/or network priorities in a timely manner. To ensure not only progress in the movement to APMs, Community will focus on success of its APM contracts by following a two-sided analytical approach to promote, educate, and transition existing and new participating providers toward the adoption and goals of alternative payment models. These two approaches will incorporate various financial and quality metrics as outlined below:
1. Financial and Strategic Payment Analysis:
The dollars spent for services under value-based agreements, including the following categories to be reviewed with internal providers at least quarterly, are:
• Drivers of spend reporting to monitor utilization and operating margin assumptions by program and service category
• Physician network comparison by specialty and geography to determine a balanced member outreach strategy
• Assess whether existing and new contracts meet expected financial objectives at multiple time intervals
• Review of sources of value such as market share impact and timing of new contractual opportunities
2. Quality Impact Analysis:
The impact of value-based agreement on the covered population. The categories to be reviewed, on at least a quarterly basis, are:
• Comparison of clinical utilization performance of physicians with established company-wide standards.
• Assess provider capabilities to provide foundational support to improve clinical efficiencies
• Implement population management measures and reporting to reduce gaps in care while improving overall quality scores
• Development of an analytics road-map to establish roles and responsibilities with providers as it related to clinical outcomes. This will be key as various value-based contract will include a downside risk /upside gain share based on performance.
• Improvement in quality outcomes resulting in potential upside gain share for providers
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