Review results and make modifications

Once the VBP model is implemented, it’s important to evaluate your performance and work with your payer to adjust the contract if needed. Negotiate this capability upfront in your contracts, such as negotiating the first year as pay-for-performance (LAN category 2C) to watch the data. It’s important to look at prior time periods to model future years.

A common challenge to understanding your performance on HEDIS measures is the claims lag. The claims lag is most pronounced in hospital data because of the billing delay. Other examples of challenges include being unable to provide the data the payer wants, or not having enough members for a given measure. If these challenges or others arise, you need to be able to make modifications, such as evaluating changes for year three of the contract in year two.

You could ask for fewer HEDIS measures, exclude some or substitute, or negotiate partial payment for performance improvement if you realize there is no way you can meet the quality target. You can also negotiate on the targets. Payers can help you understand where you are in quality by providing mid-year reports. This is not possible on the financial side because of the billing delay.