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Commercial Programs

What are Commercial Value-Based Care Contracts?

Based on the success of Value-Based Care delivery models in the CMS environment, many commercial insurance companies are moving towards pay-for-performance models. In fact, commercial Value-based contracts are expected to account for 59 percent of all healthcare payments by 2020.

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

The 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

Why it’s Important and 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, you need clinical-performance 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 optimize reimbursement.

How ReportingMD can help you excel

At ReportingMD we provide a measure driven outcome management 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.

TOM™ gives you the information you need to manage effectively

  • Aggregate claims data and payer data into a single dashboard
  • Monitor performance for all programs, from a single dashboard, simultaneously
  • Compatible with most EHR and PMS Systems
  • See performance across all clinical quality measures
    • Using standard or custom benchmarks
    • See performance specific to individual plans
    • Choose from more than 400 quality measures
  • Visibility through to the individual patient encounter
    • See performance by provider and location
    • Identify care-gaps to the individual patient encounter
  • Provides a clinical-quality performance audit trail

Our clients engage ReportingMD’s technology, backed by our expert support, to improve population health outcomes, optimize clinical performance score and enhance revenue.

ReportingMD is focused on getting you the maximum amount of money you can earn from all your pay-for-performance programs.

Find out if we can help you.