The shift to value-based care

Successfully transforming to value-based care excellence can propel a health system to market leadership.

Recognizing that risk contracting is less mature in some markets, a health system can move the market forward towards value-based care in a planned and measured way and thereby cement itself as the value-based care system of choice.

A successful value-based care organization needs new capabilities and core competencies that impact virtually every area of the health provider business model.

A successful transformation to value-based care requires a “blueprint” for a desired future state – for both managed care contracting by payer segment and value-based care competencies – which is supported by a tactical roadmap.

Alignment of all stakeholders to the value-based care blueprint is essential.

The critical considerations

Developing a financial plan that preserves operating margin during the transition to value-based care.

Building advanced capabilities in areas such as network alignment, care management, population health, data analytics and consumer health.

Designing payer contracting and partnership/relationship strategies by segment – Medicaid, Medicare and Commercial – that is responsive to the emerging insurance products and payment models in each segment.

Determination of whether to build or buy the value-based care capabilities or whether more significant transformational change can only be accomplished via partnering or merger.

The transformative change to become a successful value-based care organization must be driven by a deep, aligned commitment between the board, senior management and physician leadership.

By choosing to be a market disrupter and taking the lead in transforming the market to value-based care, the health system can take the time and resources to develop and implement the “blueprint” for change in a measured way that preserves operating margin.

Lagging behind as a market follower risks stable operating margins and can suboptimize the choices available to the health system in making the transformative change.