Value-Based Care Arrangements in Action

Value-based care continues to create new opportunities for healthcare organizations to align providers, improve outcomes, and manage costs. This webinar moved beyond a high-level regulatory discussion of value-based enterprises (VBEs) and value-based arrangements to focus on how these models are being structured and deployed in practice.

Through real-world examples, our speakers explored emerging trends in the utilization of VBEs to implement innovative physician alignment strategies and new approaches to risk-sharing and coordinating care. Attendees left with practical insights on designing, implementing, and maintaining successful value-based arrangements.

Key takeaways included:

1. Value-based enterprises (VBEs) can offer a more flexible and innovative alignment model than traditional hospital-physician structures. A VBE sits outside the traditional integration spectrum because it can align hospitals, physicians, post-acute providers, payors, and other participants around a defined value-based purpose. This structure can be implemented in connection with a wide range of arrangements – from care coordination agreements all the way to full capitation and risk sharing.
2. Newer Stark and AKS value-based exceptions and safe harbors can permit payment structures otherwise unavailable under traditional compensation rules. In a qualifying arrangement, parties may have more room to structure gainsharing, in-kind support, shared savings, and compensation tied to outcomes and value creation, rather than being limited by fair market value (FMV) compensation for specifically identified personal services. Importantly; however, such flexibilities are only available when the arrangement is structured in a manner that satisfies the applicable value-based requirements.
3. Simply labeling an arrangement “value-based” is not enough to qualify for regulatory protection. Referrals alone are never a value-based activity. Organizations still need a defined target patient population, a bona fide value-based purpose, real care-improving/cost-saving activities, and documented outcome measures. Those are some of the elements that distinguish a compliant value-based arrangement from a traditionally structured model.
4. Monitoring and governance are central to preserving value-based protection after launch. Annual check-the-box reviews are generally insufficient to maintain integrity. Performance measures should be established prospectively, tracked with reliable and timely data, and reviewed through a clearly defined governance process. Ineffective value-based activities or arrangements should be recalibrated, replaced, or unwound when the model is not advancing its stated purpose.

To view the webinar presentation materials, click here.