VALUE BASED CARE

Align incentives, design and execute win-win payer/provider contracts, and deploy enabling capabilities to ensure success in value-based care partnerships

Payers and providers are entering into new types of partnerships in response to regulatory changes, market innovation, and affordability pressures.

Increasingly, these partnerships are built with value-based care to align payer and provider incentives around improved quality, risk coding accuracy, medical cost management, and enhanced member experience.

National and state-based reforms, provider consolidation, and innovations in the provider market are expected to increase the pace of adoption of value based care partnerships – and their strategic importance for both payers and providers.

Common issues we help our clients solve

How can we align incentives to create affordability for our members and customers in the market?

How can we deliver market innovation that transcends traditional contracting and product levers?

What can we do to improve our strategic position in a competitive payer market? In an environment of increasing provider consolidation?

How can we partner more closely with providers to deliver a superior member experience?

What can we do to better manage our trend/MLR, especially during a period of rapid change in the market?

Payer value proposition of value-based care

Driven by regulatory changes, market innovation, and affordability pressures, payers and providers are experimenting with new types of partnerships–increasingly, with value based care at the center–across a broad range of market conditions, network constructs, and products.

National and state-based reforms, provider consolidation, and innovations in the provider market are expected to increase the pace of adoption of value based care partnerships–and their strategic importance for payers.

Value based care models

Value Based Care Adoption varies by market and line of business, necessitating organizations have capabilities across a spectrum of models.

Source: Oliver Wyman analysis

Value Based Care models and capabilities needed by health insurers for each line of business

Source: Oliver Wyman analysis

Four major success factors are critical to driving partnership sustainability and impact

Shared economics

Customer experience innovation

Operational simplification

Physician alignment and capability development

Case Studies

Oliver Wyman has deep experience partnering with payers to design, negotiate, and launch value-based offerings for their provider networks.

Successfully negotiated new value-based arrangements, recommended redesign of MA value-based contracts, and developed a data sharing policy to effectively manage populations. Read more

Developed high-level terms and model for a risk deal between a provider network and a regional health plan for its Commercial PPO book of business. Read more

Identified 5-year savings of over ~$650M across all lines of business by transitioning 40-50% of total membership to risk and achieved C-Suite alignment on importance of accelerating the strategy. Read more

Continue exploring

Contact Us

Additional Perspectives

Do you have additional questions about our Affordability and Quality Impact practice? Get in touch

Aditional Perspectives

Do you want to know more about Oliver Wyman’s Health and Life Sciences perspectives? Visit our Blog