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PHM Downside Risk 2021
Guiding Principles from Successful Organizations

author - Bradley Hunter
Bradley Hunter
author - Cathy McCabe
Cathy McCabe
October 14, 2021 | Read Time: 11  minutes

Current Time Inside Cache Tag Helper: 9/28/2023 11:22:10 AM and Model.reportId = 1388

In the United States, just 10% of the average healthcare organization’s revenue comes from downside risk contracts. However, several health systems are ahead of the curve, and their valuable insights on adopting downside risk can help peers figure out how to move the needle on value-based reimbursement (VBR). KLAS worked with population health management (PHM) vendors to identify which of their customers are most advanced in adoption of downside risk contracts and then conducted interviews with top executives at 15 of these organizations. We spoke with large, midsize, and small health systems as well as a handful of ACOs, highlighting the fact that with the right technology and organizational structure and buy-in, organizations of all types can make significant progress toward VBR.

The Executive Insights portion of this report explores what outcomes the organizations have achieved as well as their aggregated insights regarding keys to success, lessons learned, and potential pitfalls. Case studies for each of the participating organizations provide additional detail and can be found in the Expanded Insights section of the report.

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Current Time Inside Cache Tag Helper: 9/28/2023 11:22:10 AM and Model.reportId = 1388

Key Findings:

  1. Outcomes Achieved with Downside Risk
  2. Principles Mastered by Deep Adopters of Downside Risk
  3. Top Advice for Peers: Contract Management Is Crucial with Downside Risk
  4. Biggest Pitfall to Be Aware Of: Despite Good Progress, Additional Functionality Still Needed for Data Aggregation and Advanced Analytics
  5. Strong Integration & Configurable Functionality Can Make or Break a Downside Risk Strategy
  6. Azara & HealthEC (for Smaller Organizations) and Innovaccer (for Large) Deliver Key Insights for VBR
author - Elizabeth Pew
Elizabeth Pew
author - Natalie Jamison
Project Manager
Natalie Jamison
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2023 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.