Assess, interpret and leverage data

Like many clinics in VBP arrangements, to track and address care gaps the Corvallis Clinic must view claims data on a different provider portal for each payer with which it contracts. To reduce this administrative burden and maximize the benefit of the data, a data analyst at the Corvallis Clinic built a program in Tableau that automatically aggregates data across provider portals into a combined list. A quality specialist then uses that list to connect with patients and schedule for services if needed.

Start by collecting and using data to which you already have access and which is relevant to the VBP model(s). For larger provider entities, internal data analytics staff will manage complex data sets, interpret and analyze clinical data, and develop and interpret quality and cost performance measurements at the provider and clinician level.

To the extent possible, know your baseline performance prior to entering into a VBP arrangement to understand what performance (clinical and financial if applicable) is achievable in the proposed measurement period. To obtain common baselines, provider entities and payers will need to work together, sharing data and methodologies to ensure a consistent and accurate understanding.

Ask payers for support in identifying best practices for bi-directional data sharing given your entity’s size, resources, and data capabilities, and ask again as you advance to new VBP models.

Moda helps providers manage commercial and Medicaid members by aggregating data for all Moda and EOCCO members into a single report. Providers can filter and sort for specific lines of business if desired. They also provide simple, user-friendly reports designed to help point out opportunities for providers to improve cost and quality. A team of quality improvement specialists reach out to and engage with primary care practices to help them interpret and use the data provided.

Before you actively engage in a VBP arrangement, model it to ensure that your organization can be financially and operationally viable under the arrangement. Modeling usually requires data and potentially sophisticated data analysis in collaboration with payers and/or by external resources and consultants. Know your attributed or assigned members and understand your baseline clinical and financial data for these members and how they compare to the payer’s benchmarks.

Obtain, develop and use VBP performance dashboards to investigate where performance differs from established VBP targets or contract expectations. You can start with simple VBP performance dashboard(s), including those provided by payers, and add to and refine your VBP dashboards over time.

Payers might work with you to phase in new VBP models or performance measures by first rewarding providers for accurate, complete, and timely reporting on specific performance measure(s). This allows them to create a common baseline, or shadow-pricing approaches, before actually paying provider entities differently for performance.

Recognize that your provider entity will need VBP champions and data analytics staff (internal and/or external) able to help practices and clinicians interpret and act on performance data relevant to your and their VBP performance. The amount of data, and different ways to analyze and present performance data can be overwhelming. In addition, some clinicians and staff may prefer graphs while others want access to as much data as possible. Don’t expect perfection in your data or universal acceptance. Focus on priority areas and data and what you need collectively to move the needle on key VBP performance indicators.

Understand how any VBP model payments will be calculated and when you can expect to receive such payments from each payer.

 For example, Category 2A and Category 4 VBP models include prospective per member per month (PMPM) payments to providers. In pay for reporting (Category 2B) arrangements, providers may get extra funds every time they report on performance to a payer.  Some payers may offer additional payments to providers for reporting that they closed a performance gap by screening an eligible, attributed member for a HEDIS measure included in the VBP model. In this case, the reporting may be as part of the provider’s claim or encounter data submission. This type of VBP payment may show up as a monthly or quarterly lump sum payment to the provider for all applicable “gap closures” reported in the prior period. Since these types of VBP payment models do not assess provider quality or financial performance to a benchmark across a panel or group, provider payment is not delayed waiting for overall quality or financial results.

 In contrast, VBP payments for provider participation in Category 2C Pay for Performance (P4P) models and Category 3 Shared Savings or Downside Risk models are largely, if not entirely, retrospective, with potentially large payments (or recoupments) occurring six months or more after the end of the performance period due to the need for complete and accurate quality and financial data to assess provider performance to the established VBP targets across all attributed patients,

 Consider asking payers for the potential to obtain a portion of your VBP payments prospectively or throughout the year. For example, if a plan has a 2C P4P model, you could seek to obtain a partial payment amount at the start of the year to support outreach or seek partial payment during the year based on your P4P performance to date. The payer would retain the remainder to be paid out after all performance data is final, or to be reconciled with any Shared Savings/Shared Risk arrangements that might wrap around the 2C arrangement in the VBP model.