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Value-Based Care Managed Services 2018
The Art of Possible
Author
Warren Whitford
Author
Lois Krotz
Over the past two years, leaders from 30+ provider/payer organizations and 20+ healthcare software and services companies have helped KLAS develop and refine a framework for VBC managed services. This study includes: (1) a vendor framework showing firms’ stated capabilities, (2) details on the current state of the VBC managed services market, and (3) as part of a new approach by KLAS, a view of what is possible in VBC through in-depth case studies on how market-leading organizations are achieving positive results. (Available in full report only.) Throughout this report, note that while measured firms are compared directly, capabilities and expertise can vary significantly, and choosing a firm that fits your unique needs is critical to success.
VALUE-BASED CARE MANAGED SERVICES
INDUSTRY INSIGHTS AND CONTEXT
Value-Based Care Managed Services Framework
Over the past two years, leaders from 30+ provider/payer organizations and 20+ healthcare software and services companies have helped KLAS develop and refine the following framework for VBC managed services, which includes six pillars and, under each pillar, three subcategories:
Advisory services: Focused on helping provider organizations create a clear VBC strategy. May include implementation of initiatives.
Technology: Enables and facilitates execution of VBC strategy. May be operated by services firm.
Outsourced services: Fill temporary or long-term gaps in organization expertise and/or staffing.
FIRM DESIGNATION DEFINITIONS:
Full-Service Firms: Provide end-to-end solutions; have competencies in technology and outsourced services across all six pillars; often provide advisory services as well.
Focused Firms: Provide less-comprehensive, more-focused solutions and services; do not have competencies in technology and outsourced services across all six pillars.
VALUE-BASED CARE MANAGED SERVICES 2018
THE ART OF POSSIBLE
The Current State of VBC Managed Services
Market complexity and growth in the value-based care (VBC) managed services market have led to fluctuating customer satisfaction. This year, most firms saw solid improvement. The exception is Lumeris—the previous multi-year market leader has seen the most growth, leading to acute growing pains. There is also high variability in satisfaction within measured firms’ customer bases; the largest firm, Evolent Health, shows the highest customer-base variability and has the most unsatisfied customers, while Arcadia’s high consistency drives their leading performance among full-service firms. Across firms, promised outcomes are slow to appear and difficult to achieve.
Lumeris Stabilizes but Loses the Lead; Evolent Health’s Deliberate Changes Starting to Pay Off
Lumeris has historically been the top performer in VBC managed services, even in 2017 when they saw a several-point drop in overall score. But while their performance has stabilized this year, other firms have improved, and Lumeris no longer leads the pack. Amid Lumeris’ substantial growth, some customers report the firm has struggled to scale resources and processes. Specifically, two customers mention challenges with inexperienced, recently hired resources. On a positive note, Lumeris is still seen as a strategic partner; most respondents rate the firm highly and appreciate the firm’s continued focus on improved outcomes.
While Evolent Health has the lowest overall score, they have improved significantly in the last year by focusing on partnering with organizations that fit their business approach, setting realistic expectations, and improving relationships with non-C-level organization employees. Evolent Health is working through some growing pains, but most customers are willing to stay the course with the firm. Conifer Health Solutions has also seen improvement in their overall score, mainly because a few of the firm’s lowest-scoring clients discontinued their engagements.
Arcadia Leads with Outcomes-Producing, Analytics-Driven Insights
Arcadia has continued to improve in performance and leads full-service firms. Several respondents call the firm a true partner and praise their data-aggregation and -integration expertise and tools. Arcadia acquired Sage and their VBC managed services clients in 2015 but has since added few new customers, instead focusing on successfully implementing their technology for existing customers, a course of action Arcadia feels is vital to customer success. Caravan Health, measured for the first time in this report, serves a large number of small ACO participants (rural community hospitals). Caravan has mostly delivered well on customer expectations and offers excellent training and education. Several less-satisfied customers feel they don’t receive enough value for what they pay. Others say assigned consultants didn’t understand their needs.
Focused firms with deep expertise are often engaged for specific needs rather than end-to-end services. Premier, Health Catalyst, and IBM Watson Health (Truven) drive high customer satisfaction with strong customer service and focused, deep knowledge brought to bear for analytics and reporting for value-based contracts and programs.
Case Study Insights: Real VBC Outcomes Are Possible
Given that past research has highlighted how difficult it is to achieve tangible outcomes, KLAS took a new approach in this study by asking firms to point us to client organizations who are achieving real, measurable results in value-based care. KLAS conducted in-depth, on-site interviews with these organizations, diving into their journey, the outcomes they have achieved, and the best practices that led to their success. From these deep learnings, KLAS hopes other organizations can take away actionable insights that will help them survive the changing market and drive VBC success.
Download the full Value-Based Care Managed Services 2018 report to learn from leading organizations how to achieve success in the VBC world.
The Art of Overcoming
To learn how your peers have solved these problems, download the full Value-Based Care Managed Services 2018 report to access the complete case studies.
Losses with Medicare Advantage due to increasing high-acuity population
▶ BANNER HEALTH NETWORK (with Evolent Health)
▶ SCRIPPS HEALTH (with Lumeris)
Threat to viability from new for-profit competitors providing Medicaid after Affordable Care Act (ACA)
▶ PASSPORT HEALTH PLAN (with Evolent Health)
Need to prepare for changing healthcare landscape and shift to VBC after ACA but lacking the technology or expertise
▶ ONECARE COLLABORATIVE (with Evolent Health)
Losses with BCBS plan, desire to expand network
▶ SWEDISHAMERICAN (with Arcadia)
Due to network growth, need to scale existing hands-on support model for members
▶ ESSENCE HEALTHCARE (with Lumeris)
Creation of a new ACO that lacks the expertise or infrastructure to support population health efforts
▶ AMITA HEALTH (with Arcadia)
The Art of Partnering for Outcomes
To learn more about what your peers have achieved with their firm partners, download the full Value-Based Care Managed Services 2018 report to access the complete case studies.
The Art of Success
To learn more about how to get results, download the full Value-Based Care Managed Services 2018 report to access the complete case studies.
Take Ownership of Your Vision and Success
Define your vision and be able to articulate it to your firm. Own the project and its success—you have the most at stake and the most expertise about your organization. Lead project efforts rather than waiting for your firm to lead out.
Align Goals and Expectations
Make sure your organization and your firm have aligned values. Set a shared vision for the project. Select a firm leader who has the right expertise and leadership skills and is trusted by your key stakeholders.
Integrate Organization and Firm Teams
Get your firm involved and bought into your culture. Communicate your common purpose. Eliminate an “us versus them” mentality between your organization and the firm. Speak respectfully. Build strong personal relationships with firm resources. Increase trust by integrating firm and organization teams; have them train together, solve problems together, and even work in the same location.
Engage Physicians and Build Trusting Relationships with Them
Treat physicians with respect. Be transparent; physicians will be more comfortable with changes if they are kept in the loop about them. Communicate the why. Actively ask for physician feedback and work with physicians during the change management process. Choose well-respected clinical leaders. Establish a physician advisory council. Highlight organizational success stories. Present relevant data to physicians. Invest in incentives to encourage behavior changes.
Writer
Amanda Wind Smith
Designer
Natalie Jamison
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. © 2024 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.