Context:
A large physician group that was new to value-based care and contracting was interested in negotiating its first value-based contract with a commercial health plan. The organization requested support in educating the organization on value-based care and negotiating the value-based contract.
Approach:
Collaborating with the organization’s executive leadership and managed care team, Ridgeline developed an understanding of the organization’s market position and the payer partner’s market position. Informed by this understanding, we developed the negotiation strategy. In parallel, Ridgeline educated key organizational decision makers on the fundamentals of value-based care and contracting including best-in-class terms we would be pursuing. We led the negotiation and successfully secured the organization’s first value-based contract with a health plan.
Results:
This engagement resulted in a best-in-class value-based contract for the organization. The contract was favorable to the provider organization relative to prevailing value-based deals in the local market and provided substantial financial upside based on performance. In addition, the contract included appropriate protections for the organization as it develops its capability to effectively manage total cost of care.