Value-Based Care July 18, 2023
Value-Based Care July 18, 2023

Breaking Down Barriers to Value-Based Care Contracting: Simplifying the process through collaboration, real-time insights and comprehensive data 

Value-based care (VBC) represents a seismic shift in healthcare delivery, moving patient outcomes to center stage. Unlike the traditional fee-for-service model, which pays providers based on the volume of tests and office visits, value-based care models reward providers for delivering more effective care. As such, value-based care has the potential to drastically increase quality and reduce costs across the American healthcare system.

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But while payers and providers share the same high-level goals of improving outcomes and reducing cost, a deeply flawed contracting process is holding them back from unlocking the potential of value-based care. Providers and patients speak different contractual languages and face a hodge-podge of analog technology that makes the contracting process extremely difficult. It can take six to nine months to create a one-year value-based agreement, a byzantine process that includes months of redlining.

To accelerate contracting and the adoption of VBC models, providers and insurers need a solution that helps them collaborate so they can align their values, mission, objectives and financial incentives.

Barriers to Developing Effective Value-Based Care Models

The Centers for Medicare and Medicaid Services (CMS) has pledged that all Medicare beneficiaries must be in a value-based care relationship by 2030. As a result, healthcare systems and retail players such as CVS/Aetna and Amazon are ramping up investments in value-based initiatives.

McKinsey & Co. estimates that the number of patients treated by providers in the value-based care landscape could double in the next five years, with an anticipated 15% annual growth rate. This level of explosive growth could create $1 trillion in value for payers, providers and investors.

The industry already saw the positives of value-based care models during the pandemic. COVID-related shutdowns led to a 20% reduction in inpatient volume, a 35% reduction in outpatient volume and cost tens of billions in provider revenue, according to the American Hospital Association (AHA). However, organizations like the Capital District Physicians’ Health Plan that had already moved to value-based care models were largely protected from those risks.

Yet for too many insurers and providers, value-based care remains largely theoretical. Roughly 85% of insurers surveyed say that modeling value-based contracts effectively is their biggest barrier to adopting more value-based agreements. In fact, nearly all payer executives say they have no contract management system, have an outdated system, or use manual processes such as paper forms, Excel spreadsheets and hand-keyed data. 

Within the landscape of VBC solutions, the majority of existing Software-as-a-Service (SaaS) systems largely ignore the contracting process, focusing instead on care coordination or population health insights.  It’s as if everyone assumed value-based models were one-size-fits-all and ignored the space of modeling and “best fit” program design. This is why health plans struggle to meaningfully engage providers in risk sharing programs. You can’t fix poor design downstream and no amount of care intervention will solve a payment structure that is flawed from the start.

As part of its ongoing efforts to power healthcare innovation, Redesign Health is leading the way on researching and ideating on the challenges that impede value-based care. Now, Redesign Health is taking the next step by seeding and launching Syntax, a game-changing solution designed to accelerate VBC adoption for healthcare plans and providers.

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Introducing Syntax

Syntax is an enterprise SaaS platform that simplifies and demystifies how contracts are created and completed for all parties involved. With Syntax, teams can obtain a full view into what a value-based contract will look like in practice. Then, they can use the platform to:

  • Model: Teams can model contract scenarios by rapidly understanding Affinity (provider panel experience), configuring Attribution (plan assignment rules) and designing Incentive Terms using Contract Templates or building their own from scratch. 

  • Measure: Teams can refresh performance measurement in real time, allowing team members to preview emerging trends for course correction and value alignment.

  • Manage: Syntax serves as a single source of truth for value-based contracting, creating better management, collaboration and accurate financial reporting.

Much like business tools such as Google Docs, Notion, and Asana, Syntax reimagines the contracting process in a virtual collaborative workspace. In this secure, dynamic environment, providers, payers and their teams can share real-time insights, build trust and develop value-based contracts in a fraction of the time that it takes today.

Two elements form the core of the Syntax platform:

  • Data and contract ingestion: The flexible and secure, cloud-based data platform within Syntax gives all parties involved in the contracting process access to the same complete set of data and real-time information. This allows health plan actuaries, network managers, analysts and providers to work from the same set of data, compare savings, revenue, quality metrics and trends and negotiate contracts across one shared system.

  • A two-sided virtual workspace: Armed with the actionable information they need, teams can use the virtual workspace within Syntax to model contract terms and incentive design. Multiple collaboration tools allow health plan actuaries and analysts to easily connect with network managers who negotiate contracts with providers. Because Syntax users can connect and communicate online from any location, the virtual workspace facilitates open, candid discussions that build trust.

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Meet the Syntax Team

Redesign Health has formed an expert team of value-based care veteran professionals to lead Syntax:

  • Rachael Jones, MPA, CEO and Founder, is an award-winning healthcare executive and thought leader in the value-based care space. She brings more than 20 years of experience transforming healthcare through strategic leadership, operational oversight, product strategy, profit-and-loss management, and data-driven analytics. She most recently served as Senior Vice President of Performance Analytics and Quality at Cotiviti, where she and her team updated, refreshed and delivered industry-leading flagship analytics tools and AI solutions. She’s also worked extensively in the payer space, spending five years at Elevance Health/Anthem, leading actuarial teams, and making buying decisions on value-based care platforms.

  • Emily Walker, Chief Analytics Officer, is an accomplished leader with experience as a buyer of value-based solutions and leader of actuarial teams. Her extensive industry experience includes vendor management, provider contract and payment method modeling and end-to-end execution of value-based programming. She most recently served as VP of Payment Models, Analytics and Reporting for Elevance Health/Anthem, leading a team of more than 100 actuaries, economists, statisticians, business analysts, financial analysis, product developers and accountants. Her team led the end-to-end execution of value-based programs, providing operational deliverables, solutions enablement and industry-leading analytic insights.

  • Rami ElGawly, Head of Product, formerly Director of Product Management at Phreesia and before that DocASAP, Rami has years of experience leading product teams in digital health. He was a Product leader at Evolent Health, where he started his first tour in value-based care helping build clinical decision systems, risk adjustment and clinical analytics.  Rami started his career in EHRs at eClinical Works and worked in interoperability at Secure Exchange Solutions. 

  • Will Hudgins, Lead Engineer, is committed to creating positive change in the transformation of healthcare through data. He spent three years building Babylon Health’s data strategy, creating a data warehouse and data lake that generated strategic clinical insights for the startup company. He’s also led EHR integration efforts to reduce clinician toil and enable value-based care at scale. Prior to his time at Babylon, Hudgins worked as a data engineer for several well-known companies, including The Home Depot.

  • Campbell Hand, Chief of Staff, is an entrepreneur who has been an integral part of the founding teams of several healthcare-based companies. He most recently served as Co-Founder and Chief of Staff for Fort Health, a pediatric behavioral health company built at Redesign Health, and also was the Co-Founder & CEO of Perry Street House, a male addiction treatment facility, from 2015-2018.

Throughout the process of building the company, the founding team at Syntax has received support from industry experts within Redesign Health and from across the broader healthcare landscape:

  • Missy Krasner, Venture Chair at Redesign Health, previously with Amazon

  • Jac Joubert, Chief Actuary at Chenmed, previously with Cityblock Health and Oliver Wyman

  • Chris Dugan, VP of Health Services Strategy at Hinge Health, previously with Aetna and Humana

  • Fawad Butt, Executive-In-Residence at Canvas Ventures, previously with Kaiser and United Healthcare

  • Juliette Price, CSO at Helgerson Solutions Group, previously with SUNY and Albany Promise

  • Francois De Brantes, Former SVP at Signify Health, previously with Altarum

  • Blackford Middleton, Former CIO & Founder at Apertiva, previously with Mass General Brigham

Making Good on the Promise of Value-Based Care

Value-based care is already proven to deliver tangible benefits to providers, healthcare plans and patients. But manual processes, constant redlining and a lack of visibility hamper the industry’s ability to create new value-based models. By giving everyone access to the same information and empowering real-time communication, Syntax helps payers and providers implement the most effective value-based programs possible.