Value-based Care is Here to Stay: The Path to Accurate and Complete Risk Capture

In part 2 of our Value-Based Care is Here to Stay blog posts, we introduced a framework to break down the components of a successful risk capture program and recommended a strategy for implementation. As organizations take on increasing levels of risk, they need to understand the maturity of their processes, the workflows they need to optimize, and the levers they can pull to improve their risk adjustment outcomes. Those new to risk adjustment are often at a loss to what parts of their organization need to be involved or the right metrics to measure success. We’ve developed a maturity model to help plan their improvement path forward and achieve success in value-based care.

Value-based Care Risk Capture Maturity Model

The risk capture maturity model provides a framework for understanding the full potential of the risk capture process. Providers need to assess their organization’s current state prior to investing in any improvement efforts or solutions. This baseline can be used to measure progress and develop an implementation plan for achieving risk capture maturity.

 

Providers to the left of the model tend to rely on manual and ad hoc processes that are not designed to scale to larger populations or across multiple organizations whereas to the right side, they have made the investments to create an automated and scalable risk infrastructure. It is worth noting that a provider does not need to reach full risk capture maturity to be successful in risk-sharing arrangements – it is important however, that they understand where their organization stands and take on the right level of risk accordingly. Every provider is at a different stage on its path towards achieving risk capture maturity and their requirements and organizational capabilities are unique.

Value of Understanding the Status Quo

To implement an effective risk capture program, organizations need to understand their current processes and identify opportunities to apply interventions most efficiently. Organizations often see maturity models and jump to implementing best practices or technology-enabled solutions. However, the best start to improvement requires that organizations understand where they currently stand and, accordingly, set a baseline from which progress can be measured. No two organizations are staffing or operationalizing technology in the same way and accounting for these variations will enable organizations to identify the best strategies for short-, intermediate- and long-term implementation. Organizations will need to develop a comprehensive but customized solution that is fit for their readiness, infrastructure, process, and people that will serve as the blueprint for achieving success.

 

Click here to learn more about how providers can leverage technology and a strategic approach to achieve success in risk-sharing arrangements.