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   You know that you need help managing contracts and giving your organization a
   competitive edge but are unsure where to start. Right here. 
   
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 1. Research
 2. The Fine Print


HOW CONTRACT INTELLIGENCE CAN HELP VALUE-BASED CARE BECOME A REALITY

By Jennifer Conner

The journey from fee-for-service to value-based care has been a long and trying
one for the U.S. healthcare system.

The Centers for Medicare and Medicaid Service (CMS) set a goal for 50% of all
payments from its programs to be associated with a value-based care model by
2018. In 2022, that number stands at 38%.

Why are these models behind schedule? In a word, complexity.

On paper, the advantages of a value-based care model are obvious: payers and
providers share a mission to help patients live better, healthier lives.
Value-based care compensates for those outcomes, not the specific medical
treatments used to get there. They incentivize what works and disincentivize
what doesn't.

However, these models are difficult to design in a way that both sides feel
comfortable with the terms, and then difficult to orchestrate once in place. For
a value-based care agreement to work, there needs to be strong alignment on what
will get measured, how it will get reported, and when payments will be released.
Even when payers and providers are aligned on broad frameworks of value-based
agreements, their execution can prove to be an administrative challenge with
lots of room for risk.

The good news is that payers and providers continue to innovate toward a
value-based care future. Some of those innovations focus on the agreements
themselves—the contract.


CONTRACTS ARE THE FOUNDATION OF THE PAYER-PROVIDER RELATIONSHIP

Contracts are the foundation of payer-provider relationships – defining the
rules by which they play (and pay).

Yet, for all their importance, contracts have long remained static in many
healthcare organizations—locking the critical business information they contain
in dense legalese and tables. This has made putting contract terms into practice
a highly manual effort that delivers little visibility across an organization.
This leads to contract terms not being followed, destroying value – across all
industries, World Commerce & Contracting estimates that 9.2% of a contract's
value is eroded because the terms are not fulfilled.

Poor contract management is a nonstarter for value-based care. Without proper
controls, visibility, and management, payers and providers are challenged to be
on the same page when executing against the terms negotiated in a value-based
agreement. This can lead to misalignment in practice adjustments or the outcome
tracking and reporting required to consistently capture an agreement's
incentive. The ability to recoup costs, mitigate potential revenue leakage, and
understand the full efficacy and impact of different models across agreements,
are imperative for an organization to optimize.


THE RISE OF CONTRACT INTELLIGENCE

That's where the innovation comes in.

Forward-looking healthcare organizations are beginning to treat their contracts
as blueprints for their operations, where they capture their goals and
fulfillment requirements for these critical relationships. By digitizing these
documents and connecting them to operational systems, they can ensure those
goals are met, and compliance is achieved for payment without penalty.

At Icertis, we call this contract intelligence – ensuring the full intent of
every contract across the organization is correctly captured and fully realized.

Few areas are riper for contract intelligence than value-based care.

Consider a scenario where a payer and provider emerge from negotiations with a
value-based approach associated with their at-risk diabetic patient panel: the
contract contains the agreed-upon parameters for the population, what outcomes
will be measured and reported, for how long, and how they will be compensated
for performance.

Thanks to advanced contract lifecycle management (CLM) capabilities, building
this contract is simplified because it is managed digitally. Both sides
collaborate on a single shared document as redlines are negotiated, and
signatures are gathered. Contract metadata can be configured to capture
information on the payment model type (shared savings, bundled payment,
capitated, etc.), what regulatory authorities may be associated with it, coding
associations, and covered populations and services.

Once executed, this information flows across the organization, enabling
stakeholders to track outcomes across all the parameters just mentioned.
Obligations spelled out in the contract can be set up as their own workstream to
ensure compliance, and when it comes time to settle, finance can match what was
paid against what the company was entitled to.

All this information remains anchored to the single source of truth for the
payer-provider relationship, the contract. Contract parties can quickly
understand how a single contract is performed, or how different classes of
agreements worked. All of which make future negotiations smoother and more
data-driven.


ON THE ROAD TO BETTER HEALTH

The United States, famously, spends more than any country on healthcare but has
the worst outcomes among the 11 wealthiest countries in the world.

Value-based care can be a powerful tool in aligning our dollars to the outcomes
we want to see in our healthcare system. Contracts are a critical link in the
process and can serve as the foundation of better healthcare operations.

To learn more, visit our dedicated contract management solutions pages for
healthcare payers and healthcare providers.

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