What are the most effective strategies for achieving value-based reimbursement?

November 20, 2017 Frazer Buntin

In its November 2017 issue, Accountable Care News asked four industry thought leaders for their responses to the question “What are the most effective strategies for achieving value-based reimbursement?” Evolent Health’s Medicare ACO Solutions President Frazer Buntin’s response appeared in the publication’s “Thought Leaders’ Corner.” His response is below:

Beyond the clinical strategies, technology, analytics, physician engagement and care coordination typically discussed, there are essentials of business infrastructure that enable success:

  1. An over-arching essential is to establish a separate business unit. Value-based care is difficult and very different from fee-for-service. Borrowing time from existing staff with day jobs will not give the value opportunity what it needs for success. Establish a business unit that is dedicated to achieving clear objectives for value-based care.
  2. It’s essential to operate each value-based care opportunity as its own P&L. For a Medicare ACO, there should be a clear annual revenue target for shared savings, budgeted costs to achieve those savings (staff, technology) and a profit target. Apply the same structure to a value contract with a commercial or Medicare Advantage payer, employee population or owned health plan. The leader of the value business unit should be held accountable for the P&L of each opportunity and the total department P&L.
  3. Each opportunity should have a specific plan for how to achieve the reduction in medical expenses. It’s not sufficient to simply state, “We’re going to save 3 percent in medical expenses.” You need to know on day one how much of the savings will come from care management, inpatient, outpatient, post-acute, imaging and specialists. Having a detailed plan with a savings allocation is critical.
  4. Specific owners of each category should be held accountable on a weekly and monthly basis for executing and reporting on progress.

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About the Author

Frazer Buntin

Frazer currently serves as President, Value Based Care Services for Evolent Health and oversees the overall operations for partner health systems. Prior to joining Evolent, Frazer served as Chief Executive Officer for WhiteGlove Health, a population health management firm providing primary health care services to self-insured employers and health plans. Previously, Frazer was co-founder, President and Chief Executive Officer for Silvercare Solutions. Silvercare was the one of the largest providers of primary care and health care management services to the senior population in the United States serving 40,000 beds across six states. Prior to Silvercare, Frazer acted in several senior-level roles for Healthways Inc. and Dollar General Corporation. Frazer received his MBA from Vanderbilt University and his BS from The University of the South. He is a board member of Leadership Health Care and a 2012 recipient of the “Health Care Heroes Award” from the Nashville Health Care Council.

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