For a payer, the move from fee-for-service reimbursement to value-based payment can be a painstaking process—and not just for you, but also for the healthcare providers in your networks. But, with the right data and a proven strategy the transition to value-based care can be manageable—and ultimately successful.
3M™ Healthcare Transformation Suite helps healthcare payers implement and manage value-based care and population health programs collaboratively with providers. The suite addresses the core parts of implementing a successful value-based care initiative.
A foundation of timely, accurate and reliable data analytics is critical to a value-based care program. Having the right data makes it possible to assess your current situation, identify opportunities to improve performance, design an appropriate program and track your progress.
3M℠ Intelligent Data Asset is a claims-based data set. First, we aggregate, harmonize and cleanse claims data. Then, the data is processed so that it is risk-adjusted and made appropriate for providing metrics on cost and quality. It can be enhanced to include several other metrics, depending on your business goals.
3M has developed several methodologies to help you assess the value of care delivered. They have been operationalized for over 200 payers and health data organizations, helping them implement payment programs that lead to better patient care at lower costs. They include 3M™ Potentially Preventable Readmissions (PPRs), 3M™ Potentially Preventable Complications (PPCs), 3M™ Population-focused Preventables, 3M™ Clinical Risk Groups (CRGs), and the 3M℠ Value Index Score (VIS).
Our 3M℠ Payment Transformation Programs enables you to reduce payment variation for the purpose of aligning payment with the quality of a provider’s performance.
Total cost of care is the sum of all medical expenditures for a patient or group of individuals. It’s the total dollar cost of all services in the delivery of care, including what is paid by the insurers plus what’s paid by the patient.
By understanding where and how costs are incurred, providers can spot opportunities to shift care to more appropriate settings. Their ability to manage total cost of care is critical to remaining profitable under new payment models and competitive within their market.
Sustaining your value-based care program and positioning your organization for long-term success requires ongoing attention to several tasks, such as PCP attribution, setting and tracking benchmarks and goals, providing data to all stakeholders, and many others.
3M℠ Program Design and Performance Management combines consulting services, analytics and performance dashboards to support organizations with developing, implementing, and monitoring a value-based care program. Through performance dashboards, payers can measure specific key performance indicators, track progress toward their program strategy, and share data with providers to help them achieve shared goals.
The 3M℠ Strategic Opportunity Analysis is also used to identify your strategic opportunities to improve care and set appropriate financial and quality goals.
Hear Jeni Alm of Blue Cross Blue Shield Nebraska describe the health plan’s journey into value-based health care.
This question was posed by an audience member to speakers at the 3M Value-Based Care Conference. The answers were all “yes,” but not without qualification about how data transparency changes behavior. Precisely, the question was, “Does anybody really believe that putting up a quality score changes referral patterns or makes a patient go someplace different?”
The move to accountable care is ultimately about achieving better health outcomes at lower cost while creating a better experience for the patient. This is the Triple Aim. A narrow view of health focuses on health care, which is understandable in the United States, since a wide range of health-related expenditures are funneled through the medical system.
One of the ongoing debates in health services research concerns the relative merits of using administrative claims data versus electronic health record (EHR) data for research. Should one be preferred over the other? Some question the degree to which administrative claims data continue to be valuable for health services research given the growth of EHR systems.
The 3M℠ Healthcare Transformation Suite combines payment-related methodologies, program design, reporting and analytics tools, and consulting services to support payers with the move from fee-for-service to value-based payment.
3M℠ Program Design and Performance Management combines consulting services, analytics and software tools designed to support organizations through developing and implementing a population health or accountable care program.
The 3M Strategic Opportunity Analysis (SOA) is a comprehensive examination of health performance at the patient, clinician and system levels, which can help health plans make informed decisions and define priorities around value-based care initiatives.