Market strategies to drive transformation of healthcare delivery and payment towards value are at a cross-roads. In response, health plan VBC strategy success will depend on their ability to develop and deploy specialty VBC models.
Industry advancements in value-based care (VBC) have resulted in a meaningful restructuring of health plan and provider organizations, processes and capabilities. However, common outcomes are emerging across the industry—traditional value-based payment models are experiencing plateauing growth and financial return for health plans and providers are declining—forcing industry innovation on two fronts.
- Health plans and providers need to evolve existing primary care physician (PCP) led programs to achieve greater impact and efficiency. This evolution will require a greater push towards risk via creative risk sharing models and strategic partnerships.
- Employers and health plans need to diversify value-based portfolios to engage specialty providers under value-based incentive models. The concepts included in this whitepaper will help health plans to frame strategies in specialty value-based care.