Stop Leaving Money on The Table

Just the idea of entering a VBC, or bundled payment arrangement with a payor, can be daunting for independent providers.

"Independent" sometimes means that providers may lack access to the resources that large healthcare corporations rely on to evaluate their readiness and manage the risk that often comes with these payer arrangements. Unfortunately, independent providers may miss opportunities to maximize their practice's revenue through a payer's bundled payment program. Still, at the same time, specialty providers can no longer afford to ignore trends like this that impact your bottom line.

Instead of avoiding bundles and risk-based agreements, independent providers should find a trusted adviser or business and clinically-focused partner with specialized tools and expertise to help providers evaluate the risks and opportunities of these payment arrangements. Because there are critical differences between independent and corporate-run practices, independent providers should choose an advisor who is also fully aligned with their independent operating philosophy.

Why is it important to find the right partner to help you navigate bundled payments?

First and foremost, providers considering entering into payer agreements outside of the typical fee-for-service structure should conduct a comprehensive readiness assessment to determine if they are most likely to succeed in value-based care or bundled arrangements. Critical considerations in these assessments include evaluating the maturity of a practice's population health management capabilities, risk management capacity, internal/external stakeholder alignment, and sufficient practice leadership. Independent providers should seek a partner with experience conducting readiness assessments for independent practices within the same specialty. Ideally, the same company will also be capable of conducting financial and actuarial evaluations of similar arrangements on an ongoing basis.

Do You Have What It Takes?

Entering into bundled payment agreements also requires an operational and management structure that fosters utilization management and care coordination. Care pathways have gained popularity in promoting accountability, but private, independent practices don't always have the time or resources to create, test, and implement these pathways. Therefore, more than finding an advisor or partner with proven experience in implementing care plans is required. The proper organization should also be willing to incorporate a provider's medical expertise and experience. It is still your practice, after all.

Bundled payment arrangements also mean specialists are often on the hook for an entire episode of care. They, therefore, must be able to refer to ancillary providers who can demonstrate their ability to manage cost and quality. To do so, providers must be sure they have access to analytic tools that track and provide quality data and industry benchmarks.  

Finally, providers also need access to financial and actuarial capabilities to evaluate VBC arrangements and manage toward expected financial results. This involves modeling based on past clinical and economic outcomes, understanding medical utilization, and managing risk. Be sure to select an advisor and partner who understands that medical utilization and managing risk are much different for private practice than for a large corporate one.

How To Find Out If You Are Ready

In summary, independent providers considering VBC or bundled payment agreements with commercial payers should focus on aligning with the right advisor or partner to help them navigate the complexities of VBC, including geographical and specialty variations and risk-sharing mechanisms.

TRIARQ Health works exclusively with independent specialty providers who want to develop and refine their capabilities for VBC and bundled payment success. We believe in innovating healthcare delivery, identifying the right data for proactive decision-making, and implementing an approach explicitly designed for the independent specialist. Contact one of our advisors today if you're curious to find out if your practice could maximize revenue and preserve your independence.