Optimizing Contract Performance with Medicare Advantage and Medicaid

Since its inception, the CMS Innovation Center has developed and tested new healthcare payment and service delivery models to promote value-based care (VBC). This VBC transformation has yielded mixed results in cost savings and quality improvements with a limited impact on health disparities.  

Based on learnings from more than 50 payment models, the Innovation Center detailed a renewed vision for creating value and accountability in healthcare, addressing affordability, advancing health equity and leveraging data to support transformation. To align Medicare Advantage with value-based efforts in traditional Medicare, including the Shared Savings Program and Innovation Center models and Medicaid, the Centers for Medicare & Medicaid Services (CMS) needs insight into risk-sharing, benchmarking, quality rewards, alignment with other value-based programs and overall impact on health outcomes across programs.  

CMS is not alone in looking at data for insights that will advance VBC. Health plans and providers are looking to data to support financial, operational and clinical risk management in their value-based contracts. Advanced analytics surface trends in quality improvement and other VBC wins, as well as drive proactive clinical and social interventions when performance is lagging against metrics, threatening the economic viability of VBC.  

To understand more about the current and future states of government initiatives to buy health, not healthcare, through value-based payment models, download our eBook, “Optimizing Contract Performance with Medicare Advantage and Medicaid.”