Value Based Care 2021

Discussion for the following with respect to Value Based Care Contracting (New SOA subgroup 2021):
1.) Health Equity (SOA has a subgroup on this as well)
2.) 18/11 Initiative
3.) Triple Aim (now Quadruple Aim)

  • Patient Outcomes
  • Patient Satisfaction
  • Lower Costs
  • Physician wellbeing and perspective

4.) Member Attribution

Subscribed, I should pay attention to the professional content here. I work for an ACO organization, still kind of coming up to speed on the ins and outs of ACOs but I’ve been in VBC for a long time, prior to my year here I was in oncology VBC for seven years, and before that chronic conditions.

Sounds like your (Mathman) VBC was more for Bundles? I have seen contracts that net out the effective bundles from the actual VBC contract (for having a lower PMPM or trend). Others it has been two separate contracts and bonus structures.

We’re doing narrow networks (So my providers are the only providers in some markets), acting like an ACO, a Clinically integrated Network (CIN) model. Each product (Group, ACA, MA, Medicaid) are all separate too.

Commercial and ACA products are basically Medicare Advantage - lite. Not much risk adjustment occurs in the Commercial and ACA products, besides, mostly, an age/gender adjustment from experience year to performance year.

We tried bundles in oncology, but it was a bit of a mess. As I was leaving that space we did get bundles done with United that I felt were reasonable. The challenge is drug costs, oncologists ‘buy and bill’ most of the drugs, so they have an acquisition cost. So bundling drugs is quite a lot of risk.

Most of my work now is shared savings, either pre-post with a cost trend, or regional efficiency, or some blending of the two. We do have some MA deals where we are typically held to an MLR number. Which I get, that’s the world they live in. There is an appetite to move to full capitation, which I’m on the fence about, because I prefer retrospective trends. If you set a cap rate at the beginning of the year the trends could make or break you - would have been a windfall in 2020 with the -8% trends!

Most of our payers use some form of HCC risk adjustment, which is nice. A few either don’t adjust at all or just use age/gender.

We now have a group of Actuaries meeting on the first Thursday of the month. Scott does a good job with topics and discussions.
You can join here: Public Listservs | SOA


Thanks T-roy, I joined.

Ah I need to join. Didn’t even realize they had that subsection.

I work in the VBC arena - consultant for a while but now at a carrier.

I’ve heard the term payviders multiple times now. It’s catchy.