Contracting Tool Launched to Help Health Care Organizations Manage High-Need, High-Cost Populations

Report and Practical Guidance available to Payers and Providers

WASHINGTON, USA, July 11, 2018 / — The Pacific Business Group on Health (PBGH) and the Health Care Transformation Task Force (HCTTF), with support from The Commonwealth Fund and The SCAN Foundation, today released a report and contracting tool to help organizations effectively manage care programs that improve the health outcomes of high-need, high-cost (HNHC) patients. HNHC patients are a small percentage of individuals with complex medical, social, and behavioral needs, yet they utilize the largest proportion of national health care resources.
PBGH, a non-profit coalition of large health care purchasers seeking to increase the value of health care, and HCTTF, a consortium of leading health care payers, providers, purchasers and patient organizations dedicated to accelerating the industry’s move to value, studied best practices for high-need, high-cost populations by conducting in-depth interviews with organizations that operate sustainable, effective care management programs for HNHC patients. The report and accompanying tool explore different types of contracting and offer specific, practical guidance for payers and providers as they develop contracting relationships.

“Health care payers and providers recognize the need to better serve high-need, high-cost patients,” said David Lansky, CEO of PBGH and Chair of HCTTF. “But the prevailing payment models make it difficult to allocate the right resources and dedicate appropriate coordination efforts to their care. By establishing a deeper understanding of payment and contracting approaches, providers and payers can better sustain these programs.”
Research highlights include:

• Identifying individuals with persistently high needs and costs through risk stratification, then further segmenting by specific need type, is critical to improved outcomes and financial sustainability.

• Guaranteed access to data is critical for successful care management, as is ensuring contractual specifications on both the type of data and the frequency with which it is shared.

• For an HNHC care management program to be truly sustainable, the program should provide an ROI over the course of multiple years and meet specified contractual targets.

“Effective care management for high-need, high-cost patients is critical yet often poses significant challenges for providers and health plans,” said Jeff Micklos, Executive Director, HCTTF. “Our hope is that this report and contracting guidance will equip providers and payers with the tools to overcome some of these challenges and help drive toward long-term sustainable financial models.”

For more information about the report and contracting tool visit:

Jennifer Baskerville
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Source: EIN Presswire