Aaron Wells is a principal consultant with InfoWorks and a respected data scientist. He has an extensive background in the healthcare industry and value-based care, specifically. The following is the second in a two-part series of peer-reviewed journal articles written by him, published on MedicalEconomics.com. You can read part one here.
With a defined set of best practices, replicable estimates of the monetary value is achievable.
To date, a formal set of best practices does not exist, and further complicating this ambiguity, no one entity is leading the development of best practices for monetization of healthcare value. Confusion and lack of standardization is compounded by rapid growth in value-based contracting between Commercial payers and providers, culminating in an imperative for the industry to align on a consistent set of technical specifications, or best practices, for monetizing value in a healthcare context. This article aims to enumerate key decision points one must evaluate when monetizing value, highlight Coarsened Exact Matching (CEM) as the prominent method for monetizing value, and lastly, identify a set of best practices providers and payers can follow when entering into value-based contracts.
Best Practices for Health Care Value Monetization
The following 10 sections provide insights and guidance for both payers and providers entering into value-based contracts. The content is based my nearly 15 years of experience collaborating with payers, employers, state governments, health benefit consultants, law firms, consulting firms, and other population health program providers. Thus, what follows is derived from actual negotiations, reconciliations, and legal challenges I have been engaged in and certainly learned from over time. While the best practices described here are comprehensive, any entity entering into a value-based contract should carefully evaluate all possible factors influencing monetization of the value expected to be created.