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Commercial Programs

Commercial Value-Based Care Programs

Based on the success of Value-Based Care delivery models in the CMS environment, many commercial insurance companies are moving towards value-based care models. In fact, commercial Value-based contracts are expected to account for 69 percent of all healthcare payments by 2022.

Like their public counterparts, the commercial programs provide financial incentive to improve healthcare value and quality.

For the most part,  commercial program performance measures are divided into six “domains of care”:
• Effectiveness of Care
• Access/Availability of Care
• Experience of Care
• Utilization and Relative Resource Use
• Health Plan Descriptive Information
• Measures Collected Using Electronic Clinical Data Systems

What you can expect

Some groups are working for the healthcare industry to adopt a standard set of measurements for pay for performance models with longstanding capacity and reduced redundancy. However, with the absence of standard measurements, providers need value-based care analytic solutions that are flexible and transparent.

As larger portions of a practice revenue are earned based on value and quality, it may become increasingly complex to manage all the variables necessary to measure care delivery, identify care gaps and enhance reimbursement.

How ReportingMD can help

At ReportingMD we provide a value-based care analytic solution called Total Outcomes Management (TOM™). Using TOM™, providers have operational visibility into the clinical outcomes within their patient population.

With the rapid increase of pay-for-performance agreements with commercial payers, our clients use TOM™ to analyze, manage, optimize and report clinical quality performance of every payer contract, with measures specifically tuned to the requirements of each program.