• linkedin
  • Increase Font
  • Sharebar

    3 tips for negotiating value-based contracts

    Despite mixed signals from Washington, D.C., most healthcare stakeholders expect the transition to value-based care to gather steam in the coming years.

    For example, a 2017 Quest Diagnostics survey of 450 primary care physicians and health plan executives found that 82% said the transition to value-based care will continue, regardless of changes to healthcare policy in the nation’s capital. In other words, expansion of alternative payment models is inevitable, and nearly everyone in the industry will need to adapt.Kevin Mehta

    For most physician practices, the transition to value-based care will not be quick or easy. This notion was underscored by the Quest survey, which revealed that just 43% of physicians said they have the tools to succeed in a value-based world.

    Clearly, many physicians face significant challenges as the healthcare system evolves from the fee-for-service payment model to value-based care. For physicians, getting value-based care right starts with negotiating the correct terms in value-based contracts with payers.

    Here are three key steps physicians should follow to successfully negotiate beneficial value-based care contracts with payers. The tips are based on the assumption that physicians who are negotiating value-based contracts have performed adequate due diligence to ensure that the opportunity makes sense, given their practices’ key characteristics such as patient mix and risk tolerance. Also, because value-based care is still in its early stages, the transition to this new model is ongoing and evolving, meaning no one has all the answers yet.


    FURTHER READING: 5 reasons why your EHR isn't enough for success in value-based care


    Find a partner with the right skills: Data forms the basis for any contract negotiation, so practices need a partner that knows how to compile, mine, and effectively document internal claims and patient data that clearly illustrate the practice’s history of delivering high-quality, cost-effective care.

    In some cases, that expertise is in-house, but others may benefit from working with technology and analytics partners that have deeper experience in designing, evaluating, building, measuring, and negotiating value-based reimbursement contracts while also aligning financial goals with improved patient outcomes. Another option is to leverage the knowledge of colleagues—physicians you are friendly with, a specialty institute or your state medical society, for example.

    Next: Understand your data and practice readiness

    Kevin Mehta
    Kevin Mehta serves as chief technology officer for Payformance Solutions. Mehta focuses on building data-driven, turnkey software ...


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Latest Tweets Follow