Value-Based Care
For better or worse, no physician practice today is completely separate from other healthcare providers. You can either embrace this and be proactive in creating a network of like-minded independent peers... or eventually face displacement from corporate networks that use metrics to shut your practice out of patient referral workflows.
We have the expertise, experience, and blueprint to build your Value-Based Program (VBP) and help strengthen your practice.
Value-Based Care is Only Getting Bigger
Doctors have many legitimate complaints about the entire philosophy and process of value-based reimbursement models. From the complexity of reporting to comparisons of heterogenous patient populations to concerns that it discourages certain treatments or patient types – there’s plenty to be concerned about.
We understand that value-based care is not a panacea. However, its prevalence in American healthcare will only increase over the next ten years across both public and commercial payers. Love it or hate it, our philosophy is that doctors need to adapt and take advantage of the possibilities that this change brings.
It’s Not as Bad
as You Think
TRIARQ helps our clients maximize the revenue benefits of value-based care, while mitigating the hassles. We can help you strategize on the best way to capitalize on current and upcoming opportunities in your region across both your current and potential patient bases. We can then provide as much, or as little, operational and technological assistance as you require to implement strategic, operational, and reporting requirements for that plan.
Our successful implementation of specialty-specific value-based care programs is the ideal model for future healthcare delivery – providing the basis for ongoing innovation and practice improvement.
Value-Based Care
Model Types
Bundled Episode
Designed around a triggering event (therapy or dx), the Bundled Episode includes a warranty period to capture care associated with the triggering event. Reconciliation of performance to target occurs after the warranty period has closed.
Sub-Capitation
This model is priced to cover a subset of healthcare services for an attributed population. The risk bearer is responsible for delivering care under a fixed rate paid per attributed life, per time period.
Full-Capitation
This model is priced to cover all healthcare services for an attributed population where the risk bearer is responsible for delivering care under a fixed rate paid per attributed life per time period.
What Needs to Be Done
Success in complex value-based models is driven through clinical pathway development and adherence. We start by analyzing and optimizing:
Patient Engagement & Practice Operations:
Payers need to be engaged so that they will prioritize partnering more closely with your practice. We want them to align with your pathways of care. To do that, you must be able to show cost and quality outcomes.
Revenue Cycle Management:
Payers need to be engaged so that they will prioritize partnering more closely with your practice. We want them to align with your pathways of care. To do that, you must be able to show cost and quality outcomes.
Integrated Tools & Analytics:
An integrated platform must be built or adapted from existing infrastructure. This is crucial to enable scale, automation, and real-time visibility.
Quality Performance Management:
Infrastructure must be built to measure and report performance to optimize value.
Payer Engagement:
Payers need to be engaged so that they will prioritize partnering more closely with your practice. We want them to align with your pathways of care. To do that, you must be able to show cost and quality outcomes.
Key Components of a Value-Aligned Practice
Value-aligned practices are organized to streamline end-to-end care delivery from patient intake through treatment, recovery, and payment, all aligned to managing the total cost of care and quality outcomes.
The Expertise You Need
Creating a successful Value-Based Program has immense patient and financial benefits. However, it is a significant undertaking. TRIARQ has been there before and can guide you and your practice through each step of the process. Every engagement is unique and tailored to fit only what you need. We’re tool-agnostic, so we’ll maximize whatever systems you have in place.
Building out the infrastructure and processes to successfully implement value-based care will do more than just significantly increase your bottom line. It will ensure your ability to maintain your independence and define your patients’ treatment plans across the care spectrum.
An Easy Next Step
Moving toward value-based care in a meaningful way can seem overwhelmingly complicated. Luckily, there’s a single simple first step in every process. It’s a practice assessment that provides a clear roadmap for optimizing your practice's operations, understanding the competitive market, and identifying growth opportunities such as value-based care models.