VBC Contracting and Enablement

The ACO Enablers and Primary Care Aggregators category focuses on organizations that help healthcare providers transition to and thrive in value-based care models. These entities play a crucial role in supporting primary care practices and health systems by enabling participation in Medicare programs, including the Shared Savings Program (MSSP) and ACO REACH, as well as Medicare Advantage and commercial value-based contracts. Their services include care coordination, chronic disease management, and administrative support to streamline participation in these programs. A primary function of these enablers is to provide technology platforms that integrate data, deliver point-of-care insights, and offer population health analytics to identify care gaps and manage patient outcomes. Additionally, they assist with financial management, compliance, and regulatory reporting to ensure sustainable operations under risk-bearing models. By offering care management teams and strategies for patient engagement, these organizations foster better adherence to care plans and promote healthier patient behaviors. Through aggregation and risk-sharing models, ACO enablers empower providers to deliver high-quality, coordinated care while improving financial performance under value-based care contracts.

Network Design is a capability that risk-bearing entities use to identify and partner with high quality providers. Network Design is often an important precursor to value-based contracting because larger groups will have more negotiation leverage and because a high performing network of providers allows for more control over costs and other value-based care outcomes. Companies that provide Network Design services are typically also able to provide Care Navigation services. Criteria: - Analytics to evaluate provider quality and/or provider cost - Ability to evaluate and advise on network adequacy, or network completeness against a set of service- and geography-based requirements

The Specialty VBC (Value-Based Care) Enablers category focuses on tools and services that support the shift from fee-for-service models to value-based care across various medical specialties. These solutions help providers improve patient outcomes while optimizing cost-efficiency through tailored care models. VBC Enablers for Cardiology assist in managing cardiovascular conditions by aligning treatment strategies with performance metrics and reducing readmissions. VBC Enablers for Nephrology focus on care coordination and early intervention to improve outcomes for patients with chronic kidney disease and those undergoing dialysis. VBC Enablers for Oncology offer tools for personalized cancer care, streamlining treatment plans, and monitoring outcomes to enhance quality of life and reduce unnecessary costs. VBC Enablers for Women’s Health provide support for maternity care, gynecological health, and preventive services, ensuring care is aligned with value-based performance measures. VBC Enablers for Musculoskeletal Care focus on orthopedic and rehabilitation services, facilitating care coordination and improving recovery outcomes. Together, these specialty VBC enablers promote better patient care, improve provider performance, and support sustainable financial models across healthcare specialties.

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