Providence’s Top Value-Based Contracting Lesson Is Collaboration

January 30, 2023 - You can’t do value-based contracting alone. That is one of the biggest lessons learned from Scott Anders, MD, MBA, FAAGP, CPE, chief medical officer of value-based care and ambulatory quality at Providence. In the latest episode of Healthcare Strategies, Anders shares how Providence relies on its staff, payers, vendors, and other stakeholders to succeed in value-based care contracts covering 650,000 lives.

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“One of the greatest advances we've had in the last two years is marrying external data—payer data and claims data—with our internal point-of-care, real-time data from Epic and all the other data systems that we have to provide a blended real-time and payer look at the programs that across the system,” Anders said.

Up to half of Providence’s spend on value-based lives can occur outside of the health system’s figurative walls even though it is one of the largest health systems in the country. Providers need to find a way to combine all of the clinical and administrative they generate with outside information on their patients in order to succeed in value-based care and take on more contracts, especially if they include downside financial risk.

The problem, however, is the nature of the healthcare system. “This is a democracy. Our payers have a part in this as well, so it depends on their maturity in this space,” Anders explained.

“A major lesson learned is when you go through contract negotiations, when you think about the payers, assess their capability for data transfer, understand who has the strengths, who has the weaknesses, and build language into the contract. If you're accountable for performance within that contract, the payer has to be accountable for delivering the information for you to act on,” Anders advised.

Having the right people at the contracting table is another lesson learned. The physician’s pen is the most expensive piece of equipment in the doctor’s office, Anders said.

“Today it is a virtual pen through clicks and typing, but it isn’t about reigning in costs or reigning in physicians. It is about including them in the conversations, having physicians at the table when you look at utilizations, so we can all understand,” Anders stated.

“You give docs data, you walk through their questions, you let them understand what’s going on, so you can let them drive the results, the programs, and get you where you need to go.”

“If we’re creating programs, we can’t do it alone,” Anders stressed.