Engage and negotiate with payers

When approached as a partnership, you can engage and negotiate with payers to enter into value-based contracts that support the care you provide, are flexible to allow for innovation and achieve payer and provider goals. (1)

To prepare for negotiation, start the conversation with the payer well before sitting down to sign a contract. (2) At least 6 months in advance of the start date of the VBP arrangement identify what you will need to do differently and how you will measure and track your progress. You will need a minimum of two-years of data prior to beginning the contract to understand trends in your performance. Consider if it makes sense to look at data gathered before the COVID-19 health emergency.

To be successful you need to understand:

  • How performance will be measured (quality and cost), including data sources, calculations and algorithms to be used. Be clear that you can provide the data, manually or automated, in the formats the payer expects.
  • How the payer determines attribution, how they notify you of changes in your attributed or assigned population, and avenues you may have to question the attribution of specific patients.
  • Resources you are willing to commit for VBP success. This could be expanding access by staying open later or on weekends, creating educational resources for high-risk patients, investments to support patient outreach and care coordination, or implementing analytics.

As described in Section II Step 4 Assess, interpret and leverage data, it’s important to know what you are bringing to the table by assessing, interpreting, and leveraging your data. Data on quality of care and efficiency are key, but provider organizations may also to highlight data and capabilities that show how the value-based contract will add to a payer’s portfolio. (3)

Key questions you can ask payers:

  • What information/data can you provide to help my practice target outreach to patients attributed or assigned to my organization who have not been seen in my clinic? This could include names of high-risk patients that do not have a primary care visit and do have an emergency department visit or hospital admission.
  • What data and information can you provide to identify opportunities for my practice to improve performance?
  • What technical assistance can you provide to support success in VBP contracts?

(1) What providers need to know when negotiating value-based payments https://www.oregon.gov/oha/HPA/dsi-tc/Documents/Negotiating-VBP-agreements.pdf
(2) Note – some payers have VBP arrangements within their base contracts – such as P4P arrangements that providers should be aware of and work toward meeting, consider the potential ROI and alignment of measures across payers.
(3) https://revcycleintelligence.com/features/value-based-contracting-101-preparing-negotiating-and-succeeding