Four examples of health plans using a phased approach to value-based care success
Health Plans

White paper: How health plans use a phased approach to value-based care

March 31, 2021
Four examples of health plans building provider engagement
Chief Product and Client Officer

Earlier this year, I shared my nine best practices for value-based care success. Most of them are about fostering payer-provider collaboration and building trusted relationships. Two that resonate with me right now are:

  • Start small. Pilot new programs.
  • Identify small wins to get started and build common ground. Start with a specific initiative. Success breeds success so celebrate success.

Increasingly, our work with health plans has revealed that many are using a phased approach to value-based care. That’s because it works to create specific use cases as a place to start rather than a provider being asked to focus on her entire patient population from the outset. Equally important, savvy payers collaborate with value-based providers to identify clinical focus areas. 

Take Blue Cross Blue Shield of Massachusetts (BCBSM), for example.

In 2009, the plan launched its Alternative Quality Contract (AQC), three years after the state enacted Romney Care, a forerunner of the Affordable Care Act. The AQC sets a global budget for patient care, and is thought to have saved, on average, $461 per year per member from 2009 to 2016. More than 80 percent of Massachusetts providers participate in the program.

In the summer of 2020, BCBSM launched a pilot program for smaller and independent primary care practices. The program features:

  • Global payments that provider practices can use to “hire social workers, health coaches and case managers to address patient needs in a wide variety of ways.”
  • Upside-risk arrangements with providers and the opportunity to receive incentive payments based on quality measure performance.
  • Immediate access to support payments to help weather COVID-related revenue declines.

To help health plans and their value-based provider partners, we created a white paper with four examples of payers using a phased approach. Instead of making the risky decision to go “all-in” on value-based care, these plans are choosing a phased transition, one that involves:

  • Focused solutions addressing immediate needs;
  • Early wins and return on investment;
  • Internal support and adoption;
  • Strong payer-provider relationships and alignment on value-based and clinical goals;
  • Pilot programs with willing providers that are refined before expanding to the full provider network.

Download the white paper, How Health Plans Are Using a Phased Approach to Value-Based Care, now.

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