Premium Reports
Value-Based Care Managed Services 2016

Value-Based Care Managed Services 2016
Technology-Enabled Services to Support Your Transformation to Value

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As the healthcare market shifts from fee-for-service to value-based care (VBC), many provider and payer organizations have been left feeling that they are playing a game with constantly changing rules and which they have little chance of winning. For help handling the immense complexity of transitioning to a new business model, many such organizations turn to value-based care managed services firms. The first chart below shows several key factors organizations will want to consider when choosing a firm, including type and scope of work performed, experience with VBC initiatives, average size of client organizations, lives covered in VBC programs, and overall performance. Also important are how the firms perform in each of the five VBC pillars as well as what clinical and financial outcomes their customers have achieved.

VALUE-BASED CARE FRAMEWORK

KLAS has observed three common approaches taken by organizations preparing for the transition to value-based care (VBC): 1) tackling the transition in-house; 2) engaging a third party for VBC consulting services; or 3) engaging a third party for VBC managed services. This last approach—in which organizations engage firms for a suite of end-to-end solutions to manage the transformation and provide ongoing support for VBC initiatives—is the focus of this report. In order to be considered a full-service VBC managed services firm in this report, firms need to have core competency across all five pillars of value-based care.



1. VENDOR DNA—UNDERSTANDING YOUR FIRM'S CAPABILITIES AND SCOPE



2. VBC TRANSFORMATION: LUMERIS AND PREMIER REDUCE COMPLEXITY; GUIDANCE FROM CONIFER, XG HEALTH UNDERWHELMS

Full-service firm Lumeris collaborates to implement innovative VBC programs, and their executive team develops strong client partnerships. Premier, a focused firm, has consultants with extensive population health backgrounds and makes a complex process easier with robust tools and strategic instruction. Some clients of Conifer Health Solutions (full-service) say their transition to VBC has been hindered by the firm’s poor communication, lack of follow-up regarding customer concerns, and inaccurate reporting. Some clients of xG Health (focused) report slow progress due to underwhelming guidance and nonactionable reporting.



3. FEW FIRMS STAND OUT ACROSS KEY VBC PILLARS; VALENCE HEALTH LAGS IN ALL THREE

Except for Premier and Lumeris, few firms reliably meet customers' expectations for technology, clinical services, and administrative/health plan services. Valence Health (full-service) struggles to deliver in all areas due to an inexperienced, under-resourced staff and cumbersome functionality. Arcadia Healthcare, Aetna, and Evolent Health (all full-service) vary across pillars. Arcadia Healthcare offers proactive consultants with administrative and clinical backgrounds; satisfaction with technology can vary among legacy Sage clients depending on whether they have migrated to Arcadia's latest platform. Aetna's staff has administrative experience, though clinical experience is inconsistent. Evolent Health clients can use data to improve patient care; frustrations stem from complicated search engines, interfacing, and filters.



4. FULL-SERVICE LUMERIS, EVOLENT & FOCUSED PREMIER DRIVE IMPROVEMENTS IN FINANCIAL & CLINICAL OUTCOMES

Since the transition to VBC is still early, few organizations were able to share feedback regarding outcomes. Of the full-service firms, Lumeris best drives outcomes thanks to robust tools that show claims data, ER utilization, uncaptured diagnoses, and payer group costs. Additionally, Lumeris helps clients identify future challenges patients may face. To a slightly lesser degree, Evolent Health helps customers achieve improved clinical and financial outcomes; customers praise the firm's standardized care management, analytics, and reporting processes. Arcadia Healthcare clients struggle to improve outcomes due to limited data-analysis functionality and slow support. Premier (focused) helps clients define which goals they want to achieve and helps them choose and implement the best VBC programs for their budget and resources.

KEY TOPICS

  1. Vendor DNA—Understanding Your Firm’s Capabilities and Scope
  2. VBC Transformation: Lumeris and Premier Reduce Complexity; Guidance from Conifer, xG Health Underwhelms
  3. Few Firms Stand Out Across Key VBA Pillars; Valence Health Lags in All Three
  4. Full-Service Lumeris, Evolent & Focused Premier Drive Improvements in Financial & Clinical Outcomes
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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. © 2019 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.