As more payers and providers implement value-based care (VBC), treatment increasingly is shifting to a patient’s home or community setting. For payers, integrating community-based organizations (CBOs) into traditional care networks offers both an opportunity and challenge.
The opportunity comes in the form of social determinants of health (SDOH) that CBOs can provide to inform wellness care plans. Knowing a patient’s employment status, housing situation, transportation barriers and other nonmedical information helps payers and providers gain a comprehensive view of that patient. This enables them to suggest lifestyle changes and recommend support resources, such as smoking cessation classes.
But integrating SDOH into care coordination is only half the battle. Equally important is payers employing a mechanism for compensating CBOs as care delivery partners. Otherwise, these organizations—many of which are nonprofit or otherwise on tight budgets—lack the ability to participate in a VBC network. It is up to payers, or holders of the financial and outcome risk for the individual, then, to create the digital network infrastructure and processes to add CBOs to their VBC models and pay them for their services.
This is not simply a matter of payers scaling what they already do with providers within a VBC contract. They also must cope with the complexities of managing “many to many” relationships with other VBC stakeholders, each of whom may have unique integration challenges, data-sharing models or performance metrics. Thus, it is imperative that payers automate data sharing, results and status tracking, invoice and payment across their entire VBC models—both medical and nonmedical network partners.
To ensure an efficient process and flexibility for the future, payers are advised to adopt a partner onboarding model as the first step toward fully integrating CBOs as compensated partners in value-based contracts. Key to making any partner onboarding model work is an underlying technology infrastructure that enables VBC networks to integrate, support, leverage and compensate CBOs.
During the creation of an onboarding model, payers must identify mission-critical business processes that require technology support across all partnerships. Typically, these include digitization of unstructured data into usable information, invoicing and payment, consent capture, permitted data sharing, measurement and reporting, electronic visit verification and system administration.
Furthermore, payers must support the unique needs of each VBC stakeholder, some of which may lack the digital technology to participate. This may require payers to bridge the technology gap to ensure such partners are able to participate, gauge performance, invoice and receive reimbursement.
With a solid partner onboarding model and the right supporting technologies, payers in a VBC contract, whether a carrier or a risk-bearing entity accepting a carve-out, can meet the specific needs of individual partners and accommodate “many to many” relationships. Those technologies should include a single scalable platform that tracks performance metrics, supports business processes, manages billing and payments, and protects proprietary relationships for multiple compensated network partners.
Once payers onboard their VBC partners into an infrastructure that facilitates their distinctive roles and financial arrangements, they create high-performance networks, gaining a competitive advantage that delivers better outcomes for their members and their communities.
Lynn Carroll is the chief operations officer and John Schwartz is the chief revenue officer of HSBlox.