Value-Based Contracting Consultants
Value-Based Contracting Consultants help providers and payers establish value-based contracts and reimbursement structures. These entities typically have strong strategic advisory and actuarial services to facilitate the bespoke negotiation processes required for commercial risk contracting with health plans, and can also support contracting with other payers, like Managed Medicaid or employers, that do not have standardized structures. Their services will often include definition of reimbursement structures such as bundled payments and capitation, and guidance on establishing cohorts, network, and risk adjustment parameters.
Criteria:
- Actuarial data and analytics services to support rate negotiations
- Strategic expertise in VBC reimbursement models and risk adjustment methodologies
- Contract focused; services do not generally encompass operations
13 Results
Sort
Filter
Customers Served
Headcount
Security Certifications
Want to see a product listed?
Accorded
Claimed
Accorded Tech-Enabled Services
Company Info
Founded: 2019
Headcount: 11-50
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Health Plan, Hospital / Health System, Risk-Bearing Providers, Employers, Life Sciences
Product Overview
2 ReviewsSecurity and Compliance Certifications: SOC 2 Type 1, HIPAA
Accorded provides technology-enhanced actuarial services tailored to the specific needs of specialty care models with services including Cost & Utilization Reports, Financial Business Cases, Pricing Models, and conducting Retrospective Claims Analysis. Accorded's actuaries leverage their advanced technology platform to deliver services, ensuring that their solutions are customized to address the unique challenges and requirements of their clients.
Santa Barbara Actuaries
Arbital Health / Santa Barbara Actuaries
Company Info
Founded: 2014
Headcount: 11-50
Customers
Customers Served: Health Plan, Risk-Bearing Providers, Hospital / Health System, Ambulatory Practice
Product Overview
Santa Barbara Actuaries Inc. (SBA) is an actuarial consulting firm that works with health plans, providers, government entities, and employers. Their expertise includes risk adjustment to determine expected healthcare costs, pricing and rate setting for insurance products, calculating necessary financial reserves, and forecasting healthcare utilization and expenses. Additionally, SBA helps clients navigate regulatory compliance requirements in value-based care. SBA was acquired by Arbital Health in January 2024. Arbital Health is a technology and services company specializing in the adjudication of value-based contracts.
Care Allies
CareAllies
Company Info
Founded: 2016
Headcount: 501-1000
Customers
Verified Customers: 3
Customers Served: Hospital / Health System, Ambulatory Practice, Risk-Bearing Providers
Product Overview
CareAllies is a management services organization that partners with providers to enable success in value-based arrangements. CareAllies supports practices with services include contracting and network optimization, patient engagement, and analytics. CareAllies is a subsidiary of Cigna.
Other Categories
Castell
Castell
Company Info
Founded: 2019
Headcount: 501-1000
Customers
Customers Served: Ambulatory Practice, Hospital / Health System, Health Plan
Product Overview
Security and Compliance Certifications: HIPAA
Castell is a healthcare platform designed to facilitate the transition to and management of value-based care by consolidating and managing payer contracts. Castell performs an assessment of current practice operations, then creates a roadmap to transition to value-based care. Castell provides access to clinical and claims data, paired with machine learning and analytics. Additionally, the platform offers ongoing support, including care coordination, coding, documentation expertise, and best practice guidance. Castell is a subsidiary of Intermountain Healthcare.
Other Categories
Cedar Gate Technologies
Cedar Gate
Company Info
Founded: 2014
Headcount: 501-1000
Customers
Customers Served: Hospital / Health System, Ambulatory Practice, Risk-Bearing Providers, Health Plan
Product Overview
Security and Compliance Certifications: HITRUST CSF, SOC 2 Type 2, HIPAA
Cedar Gate is a technology company that provides value-based care performance management solutions, from upfront contracting through population health analytics and performance measurement. Cedar Gate provides actuarial services to support with contracting and administration of value-based reimbursement structures such as bundled payments. Their data and analytics solutions integrate data from multiple sources and generate insights to drive care management activities. They work with payers and providers across many specialties and different populations.
Evolent Health
Evolent Health
Company Info
Founded: 2011
Headcount: 501-1000
Customers
Customers Served: Health Plan, Hospital / Health System, Risk-Bearing Providers, Ambulatory Practice
Product Overview
Evolent is a value-based care organization that partners with health plans and providers. They help primary care practices participate in the Medicare Shared Savings Program (MSSP) through the Evolent Care Partners ACO and they support specialty practices including oncology, cardiology and musculoskeletal to transition to value-based care. They also provide analytics and administrative services to support both providers and payers in value-based care delivery.
Lumeris
Lumeris
Company Info
Founded: 2000
Headcount: 1001-5000
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Risk-Bearing Providers
Product Overview
Lumeris is value-based care company that provides health systems, payers, and providers operational support, technology, and consulting services. Lumeris advises on VBC contracting and offers risk-sharing options to strengthen its partnerships. They also provide technology, analytics and operational support to enable performance in VBC models.
Milliman
Milliman
Company Info
Founded: 1947
Headcount: 1001-5000
Customers
Customers Served: Health Plan, Risk-Bearing Providers
Product Overview
Security and Compliance Certifications: SOC 2 Type 2, HIPAA, GDPR
Milliman is a provider of actuarial products and services. Milliman’s healthcare division offers data analytics, consulting and actuarial services. Payers and providers work with Milliman on value-based care contracting strategy, pricing and risk-adjusted performance evaluation.
Other Categories
Navvis
Navvis
Company Info
Founded: 2013
Headcount: 201-500
Customers
Verified Customers: 1
Customers Served: Hospital / Health System, Ambulatory Practice, Health Plan, Risk-Bearing Providers
Product Overview
Security and Compliance Certifications: HIPAA
Navvis is a population health company that supports health systems, health plans, and physicians with a range of value-based care solutions including data & analytics, in-person practice optimization support, virtual care coordination and care management services, technology, and contract implementation. Navvis is a subsidiary of Surround Care, which was formed through the merger of Navvis and Esse Health, a value-based primary care organization.
Other Categories
Privia
Privia
Company Info
Founded: 2007
Headcount: 501-1000
Customers
Customers Served: Ambulatory Practice, Hospital / Health System, Health Plan, Risk-Bearing Providers
Product Overview
Security and Compliance Certifications: HIPAA
Privia is a national physician organization focused on administrative, financial and clinical outcomes in value-based delivery structures. Privia’s operations are structured regionally and encompass employed physician practices, physician networks aggregated through ACO and IPA structures, and MSOs that provide administrative services to medical groups. They can support providers along the spectrum of independence and risk ownership in value-based care structures. They also offer population health management tools to support. Privia also provides contracting and network design services for health plans and larger risk-bearing health systems.
Syntax Health
Syntax
Company Info
Headcount: 1-10
Customers
Customers Served: Hospital / Health System, Ambulatory Practice, Health Plan, Employers
Product Overview
Security and Compliance Certifications: HIPAA
Syntax is a value-based care contracting company that provides modeling and negotiation support for health plans, providers and employers. Their services include contract analytics to support evaluation of different reimbursement models and guidance on negotiating contract terms such as attribution and carve-outs.
Other Categories
Wakely Consulting Group
Wakely Consulting Group
Company Info
Founded: 1999
Headcount: 51-200
Customers
Customers Served: Health Plan, Risk-Bearing Providers, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
Wakely is an actuarial consulting firm that works with healthcare organizations. They provide strategic advisory and risk management services for health plans and providers, including value-based care payment model definition and pricing, contract negotiation support, utilization and cost measurement, risk adjustment, and contract reconciliation activities. Wakely is a subsidiary of Health Management Associates (HMA).
Yuvo Health
Yuvo Health
Company Info
Founded: 2021
Headcount: 51-200
Customers
Customers Served: Ambulatory Practice
Product Overview
Security and Compliance Certifications: HIPAA
Yuvo Health is a value-based care enabler for Federally Qualified Health Centers (FQHC). Yuvo Health accepts risk on behalf of community health centers and also partners with IPAs, offering additional revenue through value-based contracts and more favorable contracts as part of a larger provider network. Health centers have access to Yuvo’s Population Health team that provides analytics and advisory support in achieving quality targets.