Actively evaluating, negotiating and managing contractual relationships with Heath Plans, Provider Networks, State Agencies and other payors may require significant investment in time and effort. The complexity and investment can vary widely based on factors such as the size of the patient population, number of contracts, contractual terms, etc.
Whether you are in the contract evaluation phase or the contract management phase, ZTS can help your team succeed with your value-based contracting initiatives.
This involves research and analysis of a variety of factors.
- Gather as much information as is available: ZTS can help you understand past performance from publicly available data, needs assessment and utilization patterns from data available to you.
- Determine your strengths and weaknesses: Using information such as quality metrics, patient population characteristics such as demographics, geography, employment etc. we help you understand where you will have leverage during contract negotiation.
- For risk-based or performance-based contracts, understand financial and clinical risk: Where available, look at utilization and cost patterns using data within your organization or from data made available to you, we help you consider factors such as capitation, incentives for quality measures, reporting requirements to identify if a contract is financially beneficial to your organization.
Once a contract is finalized, your organization needs to track performance. Industry research has shown that this can significantly impact your organization’s financial outlook.
- Performance Tracking: If your contract requires you to meet quality targets, it is important for you to baseline and trend your organization’s performance and ensure that your staff is focused on the right tasks.
- Data management: Interacting with your contracting agencies requires exchange of various data such as roster lists, members missing services, performance scorecards, claims extracts, cost data, utilization alerts etc which include information critical for the success of your organization. Each agency has its own format for sharing this information – integrating this data is imperative to successful outcomes.
- Supplemental Data: While claims serve as a good data source to measure performance, they are inadequate. Having the ability to generate supplemental data to augment your reporting is critical to document and establish your eligibility for incentive payments that you deserve.
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