Trusted Healthcare Advisors
With the increasing pressure from the federal government and commercial employer groups to transition away from a fee-for-service model (paying for quantity) and shift the focus of the American healthcare system to lowering costs of care, improving health outcomes, and increasing access to care, payers and managed care organizations (MCOs) are transitioning to a value-based reimbursement model. The shift toward increased payer-provider collaboration, outcomes-based payment, and new benefit design is driving how payers and MCOs pay for healthcare and that affects how healthcare is delivered. Payers have started by shifting the primary care providers to alternative payment models, such as value-based contracting arrangements and holding providers accountable for all the patient healthcare costs (specialty visits, ER, inpatient, etc.). Some payers are even extending this to specialty care, outpatient care, and hospital inpatient contracting arrangements.
What's in it for providers?
Capitalize on the revenue opportunities and alternative payment models
Additional payments for the extra care coordination services
Additional payments for the complexity of the patient population you service
Improvement in your quality measures
More attention from MCOs/payers
Less pressure to increase daily patient volume in order to receive more revenue
What's in it for the payers?
Improved HEDIS metrics
Avoid penalties for at risk HEDIS measures
Improved Risk Adjustment, resulting in higher "premium gains"
Lessen the burden for health plan staff (care coordinators, provider reps, etc.)
Stronger relationships with your valued provider partnerships
Aids health plans in meeting their MLR targets, cost savings, resulting in a decrease in over-utilization of emergency room, inpatient, testing for radiology, lab and other services based on providers managing the patient's healthcare cost utilization
How we help
Whether your organization is on the provider or payer side of value-based care, let Allegro Healthcare help you capitalize on new revenue opportunities and improve health outcomes for your patients/members. Our team leverages deep knowledge in provider-payer contracting, value-based contracting, risk-based modeling, successful implementation of clinical cost savings and quality improvement programs, clinical informatics, medical economics, technology, and IT in order to help providers and payers win at value-based contracting, as well as improving population health, bending the healthcare cost trend, and improving the patient experience.
Find out more how we can put our insights to work for you:
- Transition to value-based reimbursement contracting & capitalize on new revenue models
- Technology strategy & data sharing
- Population health & HEDIS/quality care gap closure
- Payer-provider contracting & payer-provider collaboration
- Analytics, business intelligence, and data visualization
- Digital transformation & systems integration
- Interoperability & performance improvement