While the initial implementation phase of a value-based care (VBC) agreement is crucial, long-term success requires sustained effort and strategic relationship management. This post explores how provider organizations can build enduring partnerships with payers.

Keys to Long-Term VBC Success

Continuously Refine Care Models

The most successful value-based care partners approach their clinical model as a living system requiring ongoing refinement rather than a static program. During the webinar, Fennel emphasized the importance of constantly evolving your approach based on real-world performance data.

"I think what worked well was not just looking at the data and having a conversation about the data, but the partner coming and saying, 'I've looked at the data, I've looked at what's working and not, and here's where I need help, or here's what I'm going to do because I know it's not working,'" Fennel explained. "Being proactive and showing that you're a learning organization and that you're willing to ask for help—that was another best practice and really made for good collaborative partnerships."

This approach includes several key elements:

• Using performance data systematically to identify gaps in care delivery
• Conducting regular root-cause analyses of utilization patterns to understand what's driving outcomes
• Testing and implementing new interventions based on emerging insights
• Sharing learnings and improvements transparently with health plan partners

This commitment to continuous improvement demonstrates your organization's dedication to achieving the shared goals of the partnership while building trust with the health plan.

Deepen Payer Relationships

While your initial VBC contract likely involved primarily the payer's network team, long-term success requires building relationships across multiple departments in the health plan organization. Fennel highlighted this during the webinar:

"Within payer organizations, different teams evaluate performance through distinct lenses—actuaries focus on cost impact, medical directors prioritize clinical outcomes, finance teams assess risk exposure." He emphasized the importance of customizing your communication approach for these different stakeholders.

To build a resilient partnership, successful organizations:

• Connect with Medical Directors to align on clinical priorities and care pathways
• Engage with Actuarial teams to ensure mutual understanding of your financial impact and performance measurement methodologies
• Build relationships with Care Management leaders to coordinate efforts with patients
• Establish executive-level connections for strategic alignment and long-term commitment

As Fennel pointed out, "There are plenty of stakeholders in the background who are keeping an eye on the success of these models and have a voice in how these partnerships proceed, whether they are the actuaries, the clinical staff, the segment leaders over Medicare or Commercial lines of business. So all of those are important audiences that need to stay engaged in the process and engaged in the conversation."

These broader relationships create multiple champions for your partnership within the health plan organization, making the partnership more resilient to leadership changes or strategic shifts.

Demonstrate Sustained ROI

As VBC agreements mature, health plans increasingly focus on concrete evidence of return on investment (ROI). This requires sophisticated analytical capabilities–"If you're not hitting the target metrics or benchmarks that you set out to hit, it becomes a very different conversation if you have a very clear explanation and root cause as to the drivers of that miss. Is it related to aspects of the partnership that you could be doing better? Or is it related to aspects like case mix or unit cost changes from the health plan contracting? What is the root cause of the miss?"

To effectively demonstrate sustained ROI, organizations should:

• Show clear links between specific interventions and measurable savings
• Quantify both direct medical cost savings and indirect benefits like improved member satisfaction and retention
• Present longitudinal data demonstrating consistent improvement in clinical outcomes and cost savings over time
• Compare your performance to appropriate market benchmarks with proper risk adjustment

"By consistently demonstrating value, you position your organization as an essential partner in the health plan's strategy. This is where the power of proactive analytics comes into play—those who proactively manage their own analytics capabilities, by building a medical economics data and analytics infrastructure, maintain a distinct advantage."

Emerging Trends in Value-Based Care

As highlighted in the webinar, payers are increasing scrutiny on VBC agreements amid growing financial pressures. Fennel addressed this directly when asked if payers are ramping up scrutiny of VBC contract performance: "As the partnerships have grown and evolved and as payers have gotten more repetitions, the burden of proof coming in the door for a payer to choose to engage with a partner is increasing over time."

Given these shifts, health plans are prioritizing several key areas:

1) Scalable Solutions

"Given the administrative cost pressures, plans can't afford to partner with every partner at a small scale," Fennel noted. "So they're asking more questions of: Who can I scale with geographically more quickly? What specialty models can cover more than one condition? How good is the evidence behind the model? And do they have proof?"

Health plans are increasingly seeking partners who can:

• Expand across new markets geographically rather than operating in limited regions
• Manage broader patient populations beyond narrow clinical niches
• Develop transferable models that work across health plan member segments

2) Clear Evidence of Impact

"The expectations around guaranteed savings are going up,” and the bar for demonstrating effectiveness continues to rise, requiring:

• Robust clinical and financial data with clear methodologies
• Transparent actuarial and analytical approaches that health plans can validate
• Accurate comparative analyses against other providers in the network

3) High-Cost Condition Management

When asked what care models payers are most willing to go at risk with providers on, Fennel emphasized specialty areas:

"A lot of it, at least my point of view, is driven by areas of really high spend and substantial care delivery challenges like oncology, MSK, and cardiology. They're trying to solve problems related to utilization, fragmented care, and a lack of capabilities to adequately support patients."

Providers who can address these high-cost areas effectively will find significant opportunities for new VBC partnerships.

Evolving Your Value Proposition

As your VBC partnerships mature, it's critical to continuously revisit and refine your unique value proposition. During the webinar, Fennel emphasized the need to "reinforce how you're different from other providers. By default, you'll end up in an apples-to-apples comparison about base metrics, when at the end of the day you want to be an orange."

When reassessing your value proposition, consider:

1. How have your data and analytics capabilities evolved since the initial agreement? Are you generating insights that weren't possible before?
2. What new clinical approaches have you implemented based on what you've learned, and how are they driving better outcomes?
3. How does your performance compare to market benchmarks, and what makes your approach uniquely effective?
4. What emerging member needs could you address that align with health plan priorities?

Collaborative Problem-Solving

One theme that emerged repeatedly throughout the webinar was the value of approaching challenges collaboratively rather than adversarially. Fennel emphasized this point:

"Very often contracting can be such an adversarial process that it can get in the way of what I think is needed in these types of advanced value-based partnerships, which are partnerships that are truly collaborative."

He continued: "Being able to show the root cause analysis and come to the table and say, 'This is what's in our control, what we need to do or do differently or do better.' But then, also, being able to say, 'This is what's out of our control. Can we collaborate on things that we might be able to do together to improve on this?' Because if it's out of your control, it may be out of the payers' control as well, but it's all the more reason for you, as the provider, to have the conversation and talk about how the provider and payer can collaborate together to change things for the better.”

Conclusion

Success in value-based care hinges on preparation, proactive communication, and data-driven storytelling. By setting clear expectations, tracking leading indicators, and engaging payers collaboratively, healthcare organizations can build sustainable partnerships that benefit patients and the healthcare system alike.

As Fennel summarized: "The payer is investing in this relationship. And the payer wants the VBC arrangement with the provider to succeed. So the payer wants to be able to have honest, transparent conversations and mutually help each other if things aren't going the way they should go."

As value-based care evolves, provider organizations that embrace analytics, transparency, and adaptability will be positioned to thrive in these increasingly complex partnerships.

‍

This is part 3 of our Value-Based Care Success series. Read parts 1 and 2 to learn about preparing for VBC implementation and navigating the critical first 90 days.

Are you a healthcare organization involved in risk-bearing or VBC arrangements?
Connect with Frank at hello@accorded.com to learn how Accorded's tech-enabled actuarial products and services can help you optimize for success, or contact Eric at eric@valuestrategies.health to learn more about Value Strategies, LLC.

‍