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KLAS: Providers Turn to Outside Firms for Value-Based Care Transitions

November 20, 2015
by Rajiv Leventhal
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While some providers may have the ability to make the transition to value-based care (VBC) on their own, the vast majority of them are turning to firms who provide VBC consulting services and VBC managed services, according to a new survey from Orem, Utah-based KLAS Research.

As healthcare moves from a fee-for-service model to a value-based care model, many providers have to reengineer aspects of their business. As such, the KLAS report— "Value-Based Care. Making the Shift: Who Can Help?"—included interviews of more than 100 C-level executives, most of whom have extensive experience in VBC.  The interviews identified 33 key functions providers must do differently to make the transition to VBC.  All of these critical functions fall into three core pillars:  organizational alignment (addressing the mix, scale, and distribution of resources across the care continuum); care management (building population health capabilities, clinical protocols, and patient-centered care models to improve delivery, quality, and value of care); and reimbursement management (optimizing cost structures, resource utilization, partnerships, and care capacity to capture maximum value from alternative payment models). The report examines the impact and performance of both VBC consulting and managed care firms and their ability to help providers make the transition.

In preparation for assuming risk, providers have choices for how they build capabilities within each pillar, and KLAS has observed three common approaches: do it yourself; use VBC consulting services; or use VBC managed services. As such, the report found that many providers are turning to firms who provide VBC consulting services and VBC managed services. When evaluating providers' confidence levels and progress toward a successful VBC model, KLAS found that 100 percent of Washington, D.C.-based consulting firm’s Advisory Board clients report the firm has a high impact in meeting their triple aim objectives.  Clients of the Saint Louis-based Lumeris also gave high marks, citing the company's ability to help providers re-imagine patient care and build a more complete patient profile, KLAS said.

Providers also evaluate firms based on their demonstrated ability to prepare organizations for evolving alternative payment models. Advisory Board engenders universal client confidence by supporting governance and infrastructure development. All of Conifer’s (Frisco, Texas) reporting clients feel empowered from having been taught to use data to strategically plan for risk-bearing contracts. Arlington, Va.-based Evolent’s ability to help providers understand the market leads to high confidence in taking risk, KLAS found.

What’s more, after identifying potential matches, providers can consider firm performance. Charlotte, N.C.-based Premier succeeds in delivering detailed governance-structure planning and leadership development; however, insufficient resources is a noted concern, respondents said. In this area, PricewaterhouseCoopers (PwC’s) lower performance in an array of strategy work reflects some providers’ concerns that PwC’s boiler-plate approach can cause a disconnect between PwC’s performance and providers’ goals, according to the report.

"A provider’s first step in choosing the right firm is to weigh their needs versus a firm's capabilities," Warren Whitford, KLAS research director, said in a statement. "Although the firms we evaluated are trying their best to bring a consistent set of methodologies and processes to an inconsistent market, each provider is on a different trajectory and the market is continuously evolving. In order to survive in this new world of value-based care, providers need firms who can help them feel confident in their progress towards Triple Aim objectives…Providers can also evaluate firms based on their ability to help them prepare for alternative payment models that are a result of the VBC model.”

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