Clarify Health Blog_3 ways blue cross of idaho is using data-driven strategies to scale the adoption of value-based contracts

Value-based contracts (VBCs) can help health plans and providers contain healthcare costs while ensuring high-quality care. However, significant information asymmetry and lack of transparency pose challenges in designing, implementing, and managing VBCs. Blue Cross of Idaho (BCI) and Clarify Health recently hosted a webinar about how health plans can use data-driven strategies to scale the adoption of value-based care. Stina Redford, Director of Payment Innovation, and Nicki Venem, Value-Based Programs/MSO Services Manager, presented on behalf of Blue Cross of Idaho. Stephanie Graham, Sr. Solutions Lead, Clarify Health, moderated the discussion.

A central focus of the discussion was around how increasing transparency and sharing trusted insights with providers has helped accelerate BCI’s value-based programs. Historically, BCI found provider adoption challenging because providers were apprehensive of complex contracts and nebulous performance targets. Today, about 41% of BCI members are in a shared savings arrangement. The business has aggressive targets to scale that number to 60% over five years. Insights and data-driven strategies have been a core component in their strategic growth and success. To supercharge this growth, BCI partnered with Clarify to simplify contracts, make performance transparent, and identify clinical and financial improvement opportunities.

#1 Blue Cross of Idaho leveraged Clarify’s enterprise analytics for faster, transparent insights that providers trust

Before leveraging Clarify, BCI used five different vendors and sourced data from multiple internal departments to manually process and deliver insights across their value-based contracts. The result was inconsistent reports, disjointed presentations, substantial wait times for vendors to run analyses, and quality issues that often-wasted internal resources to resolve.

“We had to go to five different departments to run numbers and supply us with the data or insights that they have. That makes it difficult if you’re just trying to get a bird’s eye view of how we are doing. We work with Clarify to be able to use multiple insights very quickly to drill down to opportunities.”
— Stina Redford, Director of Payment Innovation at Blue Cross Idaho

With Clarify, BCI has instant access to precise and transparent insights to support provider engagement. They are able to share provider performance benchmarks at the level of discrete clinical behaviors to help providers identify opportunities to improve. To address their need to get a bird’s eye view, BCI sought Clarify’s configurable user interface, where “providers can get in and look and see [insights] all on one page.”

#2 Blue Cross of Idaho used Clarify software to identify and present new opportunities for value-based contracts to provider partners

BCI uses insights from Clarify to pinpoint opportunities for VBCs by identifying both high-performing and low-performing providers that could improve cost-effectiveness and care quality through value-based arrangements. By sharing these insights with providers directly and showing them where they have a right to win, BCI can gain strong buy-in from their provider partners from the outset.

“We’ve actually found that a lot of the providers, once they understand what value-based care is, they do want to participate. It bothers them as much as it bothers the payer, the cost of care going up. They want to lower the cost of healthcare, but they still want to provide high-quality care to their patients.”
— Nicki Venem, Manager Value-Based Programs/MSO Services, Blue Cross of Idaho

BCI identified opportunities and engaged with providers, delivering a comprehensive understanding of what a contract would entail and how it could benefit them. BCI created a department dedicated to consulting with providers to review their data to improve performance and present opportunities for specific value-based programs.

“One of the key things is just identifying the opportunities. Historically, we did not share all claims data with these providers. It was difficult convincing them to make the hurdle in the beginning based on data that they had never seen before… And so, we had to identify those cost-saving opportunities in areas that made sense and present them as well.”
— Stina Redford, Director of Payment Innovation at Blue Cross Idaho

The result has been increased interest from providers in BCI’s value-based program offerings. After COVID-19 shut-downs hit fee-for-service volumes and limited cash-flows for many providers, BCI leveraged Clarify’s insights to target hospitals that could benefit from value-based contracts. They showcased how shared-saving models could support sustainability and stabilize cash-flows.

#3 Blue Cross of Idaho built stronger provider partnerships by increasing engagement and transparency with providers

BCI wanted to increase transparency and communication with providers, but simply handing data over to providers wasn’t sufficient. During the design of value-based programs, they reached out to key provider partners to gain their input on the risk measures, quality metrics, and risk models. They sought to make the process collaborative to ensure that their value-based programs were favorable for providers. They educated their primary care providers on where they can send their members for high-quality, high-efficiency specialist care, and shared the various ways health systems could work with BCI to lower the cost of care.

“We wanted to meet the provider where they are and actually give them metrics that they have the opportunity to make changes in. There are a lot of metrics out there where it doesn’t matter how hard they try, they don’t change. But we picked metrics where there is an opportunity for them to improve. And it’s down to their participation and how well they will improve.”
— Nicki Venem, Manager Value-Based Programs/MSO Services, Blue Cross of Idaho

Sharing trusted, actionable insights at the level of discrete clinical behaviors helps providers identify opportunities to improve performance. BCI distills insights into all-in-one, easy-to-navigate packages for providers. They anticipate the types of questions providers may have about their value-based models and ensure that they include actionable insights into how the contract terms would impact providers, including providing transparency into the metrics and methods.

“So, I think one of those key things was just anticipating those types of questions or pushback in the models and making sure that we are prepared with data and insights. When you send them just files and files of data, they don’t have a lot of time to review it unless they have data analysts on their team to go in and review the data.”
— Nicki Venem, Manager Value-Based Programs/MSO Services, Blue Cross of Idaho

As Stina and Nicki like to say, “engagement in value-based care doesn’t start from the wallet, it starts from the heart.” Showing providers data they can trust and insights they can actually act on has been a big part of BCI’s success.

Investing in the right technology is critical for any health plan trying to scale its value-based care business

When value-based care is implemented at scale, it can transform the whole health care system by incentivizing stakeholders to focus on health outcomes first. However, successful value-based care models require alignment and trust between health plans and providers. Alignment and trust can be supported with data-driven strategies, but this approach relies on data transparency, simplicity and actionability. Clarify’s Value Solution is the only end-to-end software solution that addresses all of the traditional barriers to success in value-based contracts. Our solution combines value-based contracting and performance management – in self-service software – to connect the dots between clinical performance and financial impact. With our software, you can:

  • Streamline contract design, management, and payment reconciliation by digitizing the key terms, methods, and metrics used to determine contract performance.
  • Gain buy-in from provider partners using the most trusted provider performance benchmarking methodology in the industry.
  • Build strong partnerships by giving providers a real-time view of their performance throughout the value-based contract period via our self-service Provider Portal.
  • Achieve better outcomes by assessing the medical and social needs of your member populations and matching them to the right care interventions instantly.

Clarify’s Value Solution is the #1 trusted software to design and manage value-based contracts and is the leading solution for building trusted partnerships between payers and providers. Watch the full webinar on-demand to learn more about how customers like BCI are using data-driven strategies to drive success in value-based contracts.