Value-Based Contracting

4 Key Strategies to Promote Effective Payer, Provider Alignment

October 26, 2023 - Strong payer-provider alignment makes life easier for all healthcare stakeholders. While providers administer services to individuals, payers are responsible for reimbursing providers and ensuring members have coverage for their care. Aligning these two key groups is not always easy, but successful interactions can help improve member outcomes and control healthcare...


More Articles

How Value-Based Purchasing Program Design Influences Outcomes

by Victoria Bailey

Payers should consider program design intensity when implementing value-based purchasing contracts, as higher-intensity programs can lead to better care quality and greater spending reductions, a...

Blue Cross MN Partnership Expands Value-Based Care for Rural Members

by Victoria Bailey

Blue Cross and Blue Shield of Minnesota (Blue Cross) has joined forces with value-based care provider Homeward to expand access to care for Medicare Advantage members living in rural Minnesota...

Blue Cross MN Value-Based Contract Reduced Cancer Care Costs

by Victoria Bailey

Blue Cross and Blue Shield of Minnesota (Blue Cross) has announced that its value-based contract with Minnesota Oncology reduced the total cost of care for patients during the first two years of the...

Payer, Provider Value-Based Care Contract Targets Equity, Population Health

by Kelsey Waddill

Independence Blue Cross (Independence) has announced that it will renew its long-term value-based care contract with Jefferson Health. The provider will participate in Independence’s Total Value...

Elevance Health ACO Generated Cost Savings Among Fully Insured Members

by Victoria Bailey

Elevance Health’s commercial accountable care organization (ACO) program was associated with significant cost savings between 2016 and 2021, particularly among the fully insured population,...

Payer Uses Value-Based Care to Improve Musculoskeletal Disease Care

by Sarai Rodriguez

Blue Cross and Blue Shield of Florida (Florida Blue) recently formed a value-based care agreement with Healthcare Outcomes Performance Company (HOPCo), a value-based health outcomes...

BCBSRI Joins Global Capitation Model, Starts 2022 RI Life Index

by Kelsey Waddill

Blue Cross & Blue Shield of Rhode Island (BCBSRI) has entered into a global capitation agreement in its Medicare Advantage program, according to a press release which HealthPayerIntelligence...

Top 10 Most Expensive Chronic Diseases for Healthcare Payers

by Hayden Schmidt

Chronic diseases are on the rise in the United States, leaving healthcare payers with the challenge of covering care for patients with these expensive, long-term conditions. Chronic diseases are such...

Top Employer Strategies for Implementing Episodes of Care Models

by Kelsey Waddill

In order to best leverage episodes of care models, employers have to take more ownership of their own data and partnerships. When Kevin Lembo, former comptroller of the state of Connecticut, took on the role in 2010, the State of...

Low Value Care in Pediatric, Inpatient Care Cost $17M in 2019

by Kelsey Waddill

Low-value care in pediatric inpatient care has a high price tag, according to a recent study published in JAMA Network Open on pediatric hospital spending for low-value services. “As...

Humana Expands Medicare Advantage Value-Based Contract in MN

by Kelsey Waddill

Humana has announced a multi-year, Medicare Advantage value-based contract to extend access to value-based care for members in Minnesota. “This value-based agreement for Humana Medicare...

The State of Payer, CBO Social Determinants of Health Contracting

by Kelsey Waddill

Social determinants of health contracting with community-based organizations remains a complex and challenging task for payers as the demand for answers grows more pressing. As the industry’s...

Value-Based Care Challenges, Opportunities for Payers in 2021

by Kelsey Waddill

As payers continue to manage the coronavirus pandemic in 2021, this unique period in history presents alternative payment model and value-based care challenges and opportunities that are beginning to...

How Payers Can Support Population-Based Payment Model Uptake

by Kelsey Waddill

As the healthcare industry gravitates toward value-based care, population-based payment models have become the golden fleece for payers, the ultimate state of value-based care payment. Unfortunately...

4 Payers That Have Embraced Value-Based Care Models in 2021

by Kelsey Waddill

Updated 6/11/2021: This article has been updated with a quote from Blue Cross and Blue Shield of Minnesota's chief medical officer. A previous version included an quote from a partner of Blue...

Humana Joins Traditional Medicare Value-Based Contracting Model

by Kelsey Waddill

Humana has announced that it will be participating in a CMS traditional Medicare value-based contracting model and will offer coordinated care for traditional Medicare...

3 Ways to Cut Payer, Employer Gene Therapy Healthcare Spending

by Kelsey Waddill

As gene therapies become more widespread, payers continue to rely on proven strategies to reduce gene therapy healthcare spending, CVS Health’s Health Trends Report 2021 explained. The report...

COVID-19 Delays Value-Based Care Contract Negotiations

by Emily Sokol, MPH

Challenges to value-based care contract negotiations existed before COVID-19, but the pandemic set the movement back even further. Instead, provider and payer organizations have shifted focus from...