Value-based Payment

A critical component of value-based care is incentivizing healthcare providers to deliver value in administering patient care instead of service volume. Understanding total cost of care, negotiating effective contracts with your providers, and uncovering savings opportunities to fund this modernization are all part of the process. Leveraging our suite of analytics and consultative expertise, we offer a comprehensive set of services and solutions that enable rapid adoption and implementation of value-based payment (VBP) programs without the need to license products, install hardware, train staff, or provide dedicated resources.

  • Strategic Consulting – Gain valuable expertise to help meet your goals, whether you are in the earliest planning stages, running into operational challenges administering VBP programs or seeking to evaluate, optimize or expand existing VBP arrangements
  • Reimbursement based on Quality - Price claims using quality metrics to reward providers who deliver quality. Administer risk-based contracting with drug manufacturers and pharmacy networks to meet the growing industry expectation for consistent and equitable provider payment practices.
  • Episode of Care Bundling - Configure standard or custom episode bundles, mine claims from any platform to create bundles, calculate the difference between the bundle price and adjudicated claims, and produce an output file to share savings and risk with providers.
  • Total Cost of Care  – Leverage a standardized measurement system that enables unbiased evaluation of total healthcare spend, which is essential to support modern payment models. This module provides visibility into both risk-adjusted cost and resource-use efficiency, facilitating process improvement and accountability – both necessities in supporting the transition to value based purchasing.
  • Specialty Services Management – Improve medical loss ratio by reducing medical costs using consultative expertise, Preferred Partner’s unique service offerings, and reduced resource use for vendor management, helping you allocate funding and resources for VBP modernization.
  • Provider Network Administration – Evaluate the performance of your provider network based on value, considering both cost and quality performance. Implement incentives to reward top performers.
  • Provider Pricing – Price claims for complex provider contracts that cannot be configured in the typical claims system. Full forecast modeling supports iterative contract negotiations by business staff without the need for IT support, allowing users to model, forecast costs, and test contract terms and rates.
  • Value-based Pharmacy Networks – Utilize our system capabilities and expertise to establish value-based networks, and contract with pharmacy providers for participation. Evaluation of pharmacy providers can be based on any combination of prescription adherence and/or patient safety metrics. The goal is to create and continuously refine a value-based pharmacy network that improves quality for members and lowers the total cost of care..

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