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