Guest Blog: Integrating Quality Management in Value-Based Contracts

How does an investment in quality deliver value for health systems, payers, providers, and patients? From government-led ACOs to commercial contracts, successful quality management begins with strategic assessments that pinpoint where to focus improvement efforts. At Lumeris, our proven approach optimizes quality metrics in any value-based care model.

Assessing Provider Readiness

Our technology and services foster greater collaboration between payers and providers, while simultaneously encouraging healthy behavior change among physicians and patients.

My team at Lumeris starts developing a client’s quality management program by conducting a qualitative readiness assessment to understand payer and provider capabilities. Our evaluation of a network provider’s maturity level includes measuring the following:

  • Organization structure
  • Payer and risk experience
  • Infrastructure
  • Likelihood of active physician participation
  • Quality and care management programs
  • Technology in use
  • Primary population served
  • Compensation structure
  • Cultural alignment
  • Clinical and administrative leadership

Our next step is a quantitative opportunity analysis to identify areas to improve quality. With this information, we guide payers, health systems and providers in designing their overall strategy. Depending on the program type and provider readiness, we translate a client’s strategy into the appropriate tactics within provider value-based contracts.

Value-Based Contracting

Our clinicians and technologists excel in quality ratings improvement, patient-centered decision support and value-based contract management. We ensure that physician incentives are balanced, meaningful, drive adoption of appropriate technology, and aid the provider in evolving to the next level of population health management. Aligning incentives is crucial for enabling behavior change in physicians as they take on more risk over time.

Our approach to designing internal physician compensation and contract structure encompasses:

  • Aligning with payer contracting metrics
  • Tying a significant portion of compensation to value-based incentives around the cost of care, quality metrics, access, patient satisfaction, citizenship, and participation
  • Transitioning over time with increasing risk
  • Designing a model that encourages team accountability

We train providers to use actionable information to achieve better quality outcomes as part of our support for value-based contracts. As a result, they know how to use the complete and accurate picture at both the patient and population levels that our technology provides, at the critical point of decision making.

Finally, by encouraging open communication to share best practices and fostering a culture of continuous improvement around quality management, we reinforce provider engagement and behavior change. For example, we facilitate ongoing engagement through discussions and programs such as:

  • Joint Operating Committees (JOCs)
  • Medical Director calls
  • Transparency of information
  • Coordination of outreach
  • Best practice sharing
  • Collaborative competition
  • Input on plan decisions

Quality Delivers Value

Our expertise in driving patient and physician satisfaction through quality management initiatives is built upon years of experience operating a consistently high-rated Medicare Advantage Prescription Drug health plan. For the past three years in a row (2012, 2013 and 2014), Essence Healthcare achieved a CMS quality rating of 4.5 Stars.*

Powered by Lumeris, the plan earned ratings above the national average for “getting needed care” and “quality of care” metrics. Over 97 percent of Essence Healthcare patients are seen annually, and more than 80 percent of networked providers consistently state that they are satisfied with their collaborative payer partner.

Read the Lumeris Quality Management Point of View today.

*Plan performance star ratings are assessed each year and may change from one year to the next.

Not sure where to start? Talk to one of our advisors.

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