Value-Based Care
Value-based care models and programs offer financial incentives to encourage providers to reduce costs and improve quality. We offer a wide range of consulting services to help clients develop financial, operational, clinical, and strategic capabilities that support a successful transition to value-based care. We can assist with:
- Alternative Payment Models (APMs): Our team has extensive experience in the most common APMs, including bundled payments and episodes of care. We can help you navigate the requirements of these models as CMS’ value-based care strategy continues to evolve.
- Risk Adjustment & Stratification: Nearly every value-based care initiative is assessed against a risk-adjusted performance target. We can help your organization build risk tolerance and mitigate downside risk.
- Care Management: The key to successful value-based care programs is effective care management. We can help you build a framework based on utilization management with a focus on end-to-end patient experience.
- Reporting & Analytics: We continually refine our approach to analysis and reporting to meet the unique data needs of participants in value-based care programs.
- Value-Based Care Strategic Planning: Organizations with systematized, cross-beneficial, net-accretive activities in value-based care achieve better performance results. We help build governance protocols and priorities.
Managed Care & Contracting
Changing reimbursement, decreasing margins, and a national focus on price transparency continue to contribute to an increasingly complex healthcare reimbursement environment. To thrive in this environment, healthcare leaders must place a renewed focus on current and future payor partnerships. We help providers execute managed care strategies that position their organizations for long-term success. We can assist with:
- Managed Care Assessment & Strategy Development: Our professionals help summarize payor contract performance, highlight potential risks and opportunities, and outline a tailored contracting strategy that aligns with organizational objectives.
- Contract Modeling: Leveraging contracts, rate proposals, and utilization data, we can provide a summary of your organization’s current state financials along with an overview of anticipated revenue impact that may result from proposed changes to rates, reimbursement structure, or contract language.
- Managed Care Contract Negotiations: Our experienced consultants can help support payor contract negotiations by assisting you in developing proposals and negotiation strategies, performing financial modeling, drafting or exchanging payor communications, and aligning contract language with preferred terms and conditions.
- Rate Benchmarking: We can provide your organization with critical insights on how your negotiated payor rates stack up against peers within a defined market. Through data enrichment and consolidation, we normalize publicly available payor price transparency data to help develop payor- and peer-specific benchmarks in aggregate and at the service line, specialty, and procedure levels.
Financial Reporting & Modeling
When embarking on opportunities for new revenue streams, exploring startups, or expanding your influence of care, it’s crucial to make decisions backed by accurate, forward-looking data.
To help you make informed and agile decisions, we provide in-depth market analysis to indicate future demand for existing and planned services.
Our professionals provide sophisticated and reliable financial modeling services that can help you tackle financial decisions head-on, so you can invest in the future and focus on achieving health in your community.
- Prospective Reporting & Feasibility Studies: Plan for and finance your future by analyzing the demand for your existing and planned services.
- Financial System Enhancement: If a system change is the way forward, we work with you to help with decision making and implementation.
- Dynamic Financial Modeling: We’ll collaborate with you to prepare financial plans to simplify your decision-making process during strategic planning.
- Debt Covenant Management: We assist with bond and loan covenant compliance, income available for debt service ratio, financial improvement, and consultant’s report.
Strategy & Network Development
Healthcare leaders are tasked with growing their organizations, serving their patients and communities, and aligning themselves with stakeholders across the care delivery system.
Our healthcare strategy consultants help providers nationwide implement their long-term goals. The key to achieving success while maintaining financial discipline is a strong, agile strategic vision that can see through the evolving nature of our industry.
We prioritize collaboration in every engagement, working alongside stakeholders at every level of your organization—including providers, clinicians, and administrators—so when it’s time to make strategic changes, the transformation goes smoothly.
From innovative targeted payment model approaches and grounded change strategies to broad enterprise planning, affiliations, and decision making, we empower clients to envision their own unique opportunities, drive sustainable results, and enact lasting change.
- Strategic Planning: Forvis Mazars helps facilitate the strategic planning process by coordinating stakeholder participation at all levels while guiding the agile, transformational thinking required in today’s healthcare environment.
- Transaction Design & Services: We help you evaluate mergers, acquisitions, and strategic partnerships to build alignment and structures for achieving your goals.
- Clinically Integrated Network (CIN) & Physician Alignment: Our CIN services can help your organization unlock its full potential by achieving provider alignment and improving value, efficiency, and quality.
- Change Management: We can assist you in developing the change capabilities and strategies that continuous performance and innovation require.
- Service Line: Each service line has varying dynamics and unique needs. Our experienced approach can help you drive results for your internal and external stakeholders.
- Models & Governance: We help organizations design operating models that are responsive to market dynamics while reinforcing discipline, sound decision making, and focus on strategic initiatives.
