October 31, 2022

Value-Based Care Strategy

Succeeding in value-driven payment models requires fresh insights and new perspectives that enable organizations to break from the historical fee-for-service paradigm while building on expertise and capabilities already in place.

In an industry where economic models are increasingly rewarding alignment with the premium dollar, organizations that can update their business model in strategic and pointed areas will increasingly be rewarded with opportunities. A successful value-based care (VBC) strategy aligns an organization’s capabilities to create value with its economic models to capture value.
 

Sg2 Areas of Expertise

Sg2 leverages its expertise in organizational partnerships to drive success in VBC through custom strategies and structures that enable organizations to capitalize on new opportunities for creating and capturing value across all payer classes.

Positioning and Enablement

VBC Structures

  • Network adequacy and design
  • Clinically integrated networks
  • Independent practice associations
  • Physician hospital organizations
  • Foundations and collaborations

Value Creation

Clinical Model and Competencies

  • System of CARE Redesign
  • Enterprise capabilities and competencies
  • Quality and outcomes alignment
  • Care management, including disease and episode-based
  • Incentive design and funds flow

Value Capture

Payment Models

  • Strategic roadmap and prioritization
  • Financial modeling
  • Program and contract evaluation
  • Contracting arrangement terms
  • Downside risk mitigation
  • VBC Partnerships

 

Payers: Medicare, Medicare Advantage, Medicaid, Commercial, Direct to Employer

Payment Models: Accountable care organizations, episodes, bundles, capitation, provider-sponsored health plans/cobranding

Value-based Care Organizational Assessment

Our Core Competencies assessment provides a proprietary framework for evaluating an organization’s VBC infrastructure capabilities and gaps against the Triple Aim goals of:

  1. Improving population health
  2. Enhancing patient experience and outcomes
  3. Bending the health care cost curve

 

Medicare Fee-for-Service

Enhancing Oncology Model (EOM): EOM aims to enhance the quality of care provided to cancer patients covered under Medicare Traditional while reducing Medicare fee-for-service expenditures. Learn more about EOM.

ACO REACH (Realizing Equity, Access, and Community Health): ACO REACH is the redesigned and renamed Direct Contracting (DC) model. Similar to its predecessor, ACO REACH is designed with two risk-sharing options in mind and focuses on empowering beneficiaries, reducing provider burden and accelerating risk assumption. Learn more about ACO REACH.

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Our Experts

Tawnya Bosko, DHA, PhD

Senior Principal, Sg2 Consulting
A nationally recognized expert, Tawnya Bosko partners with clients to develop successful value-based care enterprise strategies and provides program-specific guidance on financial modeling and physician-hospital alignment.

Keely Macmillan, MS

Associate Principal, Sg2 Consulting
Keely Macmillan leads engagements that assist health care organizations’ transition to value-based payment and delivery models, partnering with provider organizations to identify and implement strategies for success in alternative payment models, including shared savings arrangements, capitation and episodic payments.

Joe Maher, CPA, MBA

Associate Principal, Sg2 Consulting
Within value-based care, Joe Maher partners with organizations to bring together advancing economic models and structures that align with the organization’s clinical care delivery approach.

William Ringwood, MBA

Senior Director, Sg2 Consulting
Bill Ringwood specializes in financial planning and forecasting for value-based care, physician alignment, managed care contracting and payer strategy initiatives.

 

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