Disputing VBC contracts now, or getting ready to? If so, you’re not alone. Modern Healthcare’s recent article details the issue and our comrades at Coral Health Advisors also shared their thoughts on the topic in their weekly newsletter.
Tension between payers and providers is facts and seems to be getting worse. Costs of labor, supplies, pharmaceuticals, and more administrative hoops are compounding, adding to the tension and burnout for physicians. Health Plans are focusing on risk mitigations for cost containment efforts with reported increased denials and hoops for prior authorization approvals rather than relieving administrative burden for providers and members.
At Syntax we're realists. We get the issue, because we lived it. But we don't subscribe to the idea that this friction is immutable. And you shouldn’t either. The fee for service payment model is fundamentally flawed, adding to tensions, as providers fight for every penny per service and payers scramble to offset and neutralize that increase’s effect to the bottom line. VBC—done right—is a better way. And just to be clear, done right doesn’t mean there’s only one, standard, “take it or leave it” design for all to adhere to. Done right is a commitment to differentiating the payment model design for providers, to sharing more strategic insights and assumptions instead of black box modeling and output, and to transparently showing how the math works with various terms applied.
With Syntax, we've designed real, tangible ways to reduce payer/provider friction by:
Collaboratively designing VBC model terms and parameters,
Promoting transparency internally and externally on assumptions and projections
Negotiating terms in the only two-sided dynamic platform on the market.
In order to rehabilitate relationships between payers and providers, trust needs to be rebuilt, and Syntax promotes that transformation by encouraging transparency and true payer/provider partnership functionality.
But don’t just take my word for it. One of our earliest clients, an FQHC in Florida, has seen how the Syntax solution can help negotiate VBC terms with fact-based, financially-sound modeling capabilities and gain faster agreement and contract adoption.
“Don't understand your insurance contracts? You're not alone! In healthcare delivery, understanding the crucial role of actuarial support is a game-changer, and this platform is a testament to that. It ensures healthcare services are accurately calculated and appropriately valued, which is crucial for those transitioning to value-based care. This tool is indispensable for anyone dealing with health insurance, aiming to refine care delivery through precise, value-focused analysis.”
- Shaun Garcia, CQO Brevard Health Alliance
We aren’t buying the narrative that VBC doesn’t work, that it’s too complicated or that it’s a sham for health plans to find some other way to withhold payments to providers. Done right, with a firm, fact-based foundation, providers are incentivized to autonomously ensure care isn’t wasteful, payers reap the benefits of predictable and stable costs, and patients are getting needed care without the headaches of denials, balance billing, etc.
Here are three ways to make your negotiations friction free:
Show the order of operations
Lose the “gotchas” from VBC agreements
Share data details and interim performance, and include it in your contract language
Proactively commit to detailed data sharing in VBC agreements
Implement technologies to allow for scaling while still negotiating differentiated terms
Efficiently scale your VBC programs to meet CMS requirements
Engage better VBC contracts and get better results
You don’t have to figure these out alone, our Syntax team can help. See Syntax in action in our demo highlight video and book a meeting with us at info@meetsyntax.com.
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.