WHAT IS THE FUTURE OF VALUE-BASED CARE?

Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.

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Two health care workers looking at a document

Value-based care should be more than a buzzword by now

Risk-based payment is progressing slowly but steadily for Medicare and Medicaid. The same can’t be said for commercial contracts, where it’s harder to find alignment between plans, providers, and employers on compressed timelines. But commercial risk is ultimately what will tip the industry toward value-based care or keep us in a world of hybrid incentives.

We believe that commercial risk is complicated, but possible. To chart the course forward, we’ve collaborated with experts from across health care and analyzed a national database of commercial claims. Explore our work below to learn how you can push the industry toward a new cost and quality standard.

 

Takeaways from our analysis of commercial claims

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Data Analysis
Where the commercial risk opportunities are

Our analysis of a national database of commercial claims illuminated where opportunities to improve cost and quality outcomes for the privately insured exist – and where we might see increased costs.

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Data Analysis
Pregnancy care opportunities

Maternal health outcomes in the U.S. lag those of other industrialized nations despite significant spend. Find out where you should focus, and where you should not.

Woman receiving chemotherapy at home
Data Analysis
Chemotherapy opportunities 

Chemotherapy spend in commercial is high and growing. It’s a difficult area to tackle—especially across patients, employers, plans, and providers—but there are areas you can prioritize today.

Looking at data
Data Analysis
What's the time horizon for results? 

The window for reducing commercial costs is likely shorter than with Medicare, but there are opportunities in episodes of care that are typically completed before patients switch health plans. Our research is in progress and will be available soon. 

 

The barriers and fears standing in the way of progress

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Research
The barriers to commercial risk

It’s hard to find consensus on the future of commercial risk. Learn about the many reasons for pessimism, but also why some view it as a necessary pursuit.

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Blog Post
The four fears holding the industry back

In a recent workshop with 44 executives from provider, health tech, life science, and finance organizations, we surfaced top fears about taking on commercial risk.

For members: Featured resources to support implementation of VBC

Win physician buy-in for value-based care

Four principles to successfully engage your frontline clinicians in VBC

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How health plans can support providers in risk

Three ways that plans can get providers more comfortable with risk

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Population health cheat sheet library

Cheat sheets to get you smart on population health basics in 5 minutes or less

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How to scale chronic disease management programs

Three steps for developing a scalable and effective program

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How to improve your risk performance

Insights on what makes ACOs successful, based on analysis of MSSP data

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Refining your approach to risk stratification

Three ways to find the high and rising risk patients who are also actionable

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