Creating a Win-Win Alternative Payment Model Strategy for Payers

December 05, 2022

Advancements in technology are revolutionizing the healthcare industry. With the emergence of Alternative Payment Models (APMs), healthcare providers are adopting new best  practices to succeed, while payers are looking for innovative approaches towards offering value-based care programs within their networks.   

Alternative Payment Models are designed to ensure the healthcare industry remains equitable and healthcare providers get appropriate incentives for their participation while maintaining cost-effective and high-quality patient healthcare.  

What are Oncology Alternative Payment Models?

Oncology alternative payment models feature bundled payment structures where medical practitioners get periodic payments to provide advanced health services to beneficiaries. Services may include evaluation of social needs related to their health, electronic patient-reported outcomes implementation, and care planning, among other services.  

Alternative payment models may refine the cancer care workflow to provide patients with low-cost, high-quality services and round-the-clock access to care. Medical providers will get performance-based payment and involve different players to ensure cancer patients get the best care, despite their health coverage.  

Why Are Payers Looking into Value-Based Care?

Payers are increasingly looking for value-based care for several reasons:  

  • Drive Financial Efficiency and Quality of Care

    Through alternative payment models, payers can enhance the efficiency of their operations by offloading the administrative burden. Synchronizing regulations across the programs used by the different players will create transparency among silos. Simplified reporting will also reduce the administrative burden, saving time and money.

  • Improve Member Experience for Providers and their Patients

    Payers are keen on enhancing their patients’ experience by adopting the models. Patients can enjoy better outcomes through their robust controls when it comes to paying for healthcare services. Value-based healthcare reduces patients’ needs with ongoing care, reducing healthcare spending.

  • Become an Instrumental Player in the Health Ecosystem

    Payers are adopting value-based healthcare to become a critical player in providing equitable services in the US healthcare industry. Ensuring patients get value-based services that focus on providing patients with preventive care may help create more equitable access to care.

  • By supporting value-based care, payers will contribute to a healthier population with fewer severe conditions.

How Can Creating Alternative Payment Models Solve This?

With the right technologies, infrastructure, and culture, payers can create synergies with providers and their patients for the benefit of all. Here are some considerations to keep in mind when investing in value-based care models:

  • Create Disease-Specific Models

    Value-based care creates a win-win situation for patients, providers, and payers. The payment model looks to personalize healthcare whereby the medical and social services align with patients’ needs and employ precision medicine.

    Value-based models reduce costs by eliminating the risk of false economics. Especially in oncology, where treatment costs are high and data-driven decisions may enable precision oncology, alternative payment models will match medical needs with care interventions for better outcomes and cost-effectiveness. 

  • Increase Transparency

    Value-based healthcare models will ensure payers put in place the proper infrastructure to enhance transparency in the processes. Enhancements will achieve this by designing better and simpler contracts that streamline management to attract incentives that motivate healthcare providers.   

    Payers can manage payment reconciliation and value-based contracts by digitizing settlements efficiently and improving trust. 

  • Improve Performance

    Through value-based care platforms built to support alternative payment models, payers can identify opportunities for improvement by analyzing claims and clinical data.

    Through digitization, they will access data that will help them understand how financial impact and clinical performance relate and find ways to provide better care.

  • Use Technology for Decision-making

    With technology in value-based care and alternative payment models, payers can make efficient decisions for the betterment of the beneficiaries.  

    With real-time data, they will understand why services are necessary, how specific services will impact positive outcomes, and how they can work with other stakeholders to improve the healthcare ecosystem. 

Interested in how Integra Connect can help you with a value-based alternative payment model? Complete this short form and one of our solution consultants will help you get started on the path to value-based care success.

October 2022 webinar

Request the recording to hear from value-based care experts about new approaches to administering APMs, including how this supports providers + practices