“How long will this take?” It’s likely you have asked this question at the auto mechanic, while waiting in the doctor’s office or at the middle school band concert. If you happen to work in the business of healthcare, particularly in network management, you’ve probably asked this question even more often in health plan/provider negotiation meetings, when a counterproposal is made, or in joint operations meetings when your team is called to task to explain patient roster discrepancies. The toil of today’s analytic backlogs supporting value-based care (VBC) contract modeling and operations is costly. It doesn’t have to be this way.
Before we can offer solutions, we need to understand the problems.
By design, modeling scenarios and terms for VBC is far more complicated than FFS, and many analysts are left to manage and do both types of analysis with the same time assumptions and resources. Requests for measuring and managing interim performance programs are also flooding in - attribution clarifications, appeals to results, etc. In a former role, overseeing the value-based care analytics and operations, my analytics team had on average, 36 data detail, reporting, or analysis requests per week. The turnaround time varied by request type and complexity, but rarely did our team have the luxury of time, often answers were expected in less than 2 days, but analyses took anywhere from +12 to +48 days to complete. Sound familiar?
The consequences of managing an ever increasing backlog with ever shrinking resources are delayed contract signatures, provider dissatisfaction, distrust, and lower adoption of risk-bearing VBC payment arrangements. Earlier this year, I met with a VP of Value Based Reimbursement who shared that he and his team had spent the last 6 months just reconciling the baseline claims data - a painful data management exercise that was exhausting everyone. While the original objective had been to negotiate downside risk terms with the provider, the first meeting to review proposal options was derailed almost immediately when the provider group raised a red flag with, “<Insert Health Plan>, your baseline is wrong.” Negotiations to advance a risk sharing payment arrangement went on hold while the “data teams” of both plan and provider got to the grueling work of comparing details down to the claim line level. Keep in mind, this particular health plan has over 550 provider contracted entities. Imagine if just 10% of these arrangements have similar debates and delays? That translates to 1,430 business days wasted debating baseline data instead of collaborating to forge meaningful value-based arrangements that drive real impact to cost, quality and patient outcomes.
What if there was a better way?
As an analytic leader, I saw very few options besides accepting this fate and putting in for more headcount. Imagine how much more effective I would have been if I was able to invest in tech-enabled automation to support my team's efforts? It’s time for us as healthcare analytics leaders to double down on embracing and adopting technologies that promote transparent modeling. We need collaborative workspaces that break down silos and bring cross functional teams to work together using data sourced from the same instance. This is a lifestyle change.
So far, VBC hasn’t fully realized its potential. This is because committing to a long term, improved state for supporting analytic, reporting and data needs in VBC won’t happen without investment. While some have touted new solutions and capabilities, offering flair and pizazz focused in patient facing areas like care delivery or AI-enabled member outreach - the rest of us, , actuaries, analysts and health economists are likely still using “tried and true” tools (MS Excel and SQL or SAS). My colleagues at health plans, “payviders” and health systems across the industry are still copy/pasting, data managing, and coding complex excel calculations to get as-accurate-as-possible modeling done to support VBC contracting, with less and less time for deep validation and greater demand for the defensible detail.
We can significantly improve efficiencies in our modeling and management of VBC.
That’s why I’m excited to finally see a focus on equipping us “doers” with new tools, like Syntax - where we’ve developed a dynamic, two-sided platform to support step-by-step building blocks of VBC, showing the impacts to attribution, spend, premium, etc. as exclusions are debated, targets are negotiated, and quality terms are adjusted. If negotiations were done 40% faster, and the routine requests answered on the spot, what would your week look like compared to today?
If you’re skeptical, that’s fair - I was too! But I’ve spent the last 365 days learning Shakespeare had it right - “Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.” I invite you to put us to the test. Let our team show you how to break free from the embattled contract processes you’ve been stuck with.
Why not consider ways to improve efficiencies in your modeling and management of VBC?
Emily Walker is an accomplished 20 year healthcare analytics veteran with strong analytical and story-telling skills, a propensity for creative problem solving, and passion for transforming healthcare.