Improving value-based care with contract lifecycle management

Managing value-based care contracts is no small feat. Inefficiencies in these complex agreements can drive up administrative costs and divert resources from what truly matters—patient care. In a recent webinar, industry leaders from AWS, Virsys12, and Conga shared actionable strategies to simplify value-based care contracts using contract lifecycle management (CLM) solutions.

The panel discussed that while value-based care contracts can promote better coordination and cooperation among healthcare professionals and reduce redundancies and unnecessary or avoidable services, successfully executing and managing these contracts isn’t easy.

One reason is that payers and providers of service often struggle to transform unstructured contract data into actionable insights and integrate it into care delivery and payment systems.

CLM brings structure to this unstructured environment.

Data integration and analytics: the linchpins of successful value-based care partnerships

Brian Cardinell, Global Head for Payor Business Development at AWS, explains that data complexity and a lack of actionable insights can quickly compound the dynamic tension between payers and providers in value-based care contracts.

“Leadership teams on both sides are looking for affordability, growth at scale, better provider-payer relationships, optimized patient experiences, and digitized support for value-based care, for example, by accommodating virtual care options,” he says. “At the same time, merger and acquisition activity— mainly aimed at lowering costs—is expected to intensify over the next few years.

“All this heightens the need for smart, structured, value-based contracts, advanced data integration and analytics, and organizational change management. “Today, the importance of being data-driven and numbers-focused can’t be understated.”

Our panel considered some of the ways suboptimal data management exacerbates common challenges associated with value-based care contracts:

Payer challenges

• Performance metrics tracking: Without data insights, tracking diverse quality and outcome metrics across multiple providers serving diverse populations—from small rural facilities to big inner-city hospitals, each with different systems and levels of capability—is fraught with complexity.
• Cost management: Monitoring and managing costs associated with value-based contracts while ensuring profitability is a difficult balance to manage.
• Risk assessment and sharing: Understanding the diverse populations different providers serve and assessing and sharing financial risk in shared-savings models can be complex, especially in unanticipated high-cost care situations.
• Data silos: When data is fragmented across bespoke and legacy systems, it’s hard to achieve a comprehensive view of patient outcomes.
• Regulatory compliance: All contracts—and the data processes that underpin them—need to comply with increasingly complex regulatory requirements.

Provider challenges

• Resource allocation: Without data-driven insights, providers of care struggle to assign the correct level of resources to meet specific outcome metrics for patients from different populations and ensure patient care isn’t compromised. This can be a challenge in particular for smaller institutions.
• Cost management: Often, it’s difficult to integrate data from payers and other systems to gain a well-rounded understanding of both care quality and costs.
• Outcome documentation: By their nature, value-based care contracts must be supported by accurate documentation and reports that detail patient outcomes to ensure payment and compliance.
• Payment delays and accuracy: Manual work can introduce billing and payment errors, delays, and disputes. This can lead to cash flow issues for providers.
• Administrative burden: Given the increased reporting and management burden associated with value-based care contracts, admin teams often find themselves stretched to the limit if they lack automated reporting capabilities.

Structuring data helps payers and providers better track and report on key metrics

In value-based care contracts, providers and payers need to be aligned regarding the program's intent and the desired outcomes for the patient population. The underpinning contracts also need to clearly define how value is measured.

Most value-based care contracts must be regularly evaluated against clinical patient outcomes like readmission rates and chronic disease management success (e.g., blood pressure, diabetes). By integrating and analysing both unstructured and structured data and creating new data models, payers and providers can better track and report on these key metrics.

Payers and providers of service also need to continually monitor and report on contract financial performance (for example, the total cost of care and shared savings amounts) and identify areas for further cost savings.

Both contracting parties are expected to measure resource usage, look for ways to improve efficiencies and identify opportunities to further optimize patient care. This might involve examining the length of patients’ hospital stays, the frequency of emergency room visits, and patients’ participation in and adherence to preventative care programs.

Naturally, both payers and providers of services want to minimize their legal and regulatory risks and ensure they adhere to all their contract obligations. This makes accurate documentation and timely regulatory reporting vital.

And to track satisfaction rates and ensure care is patient-centered and aligns with quality goals, payers and providers must gather and analyze patient experience scores and follow up with patients to ensure they're adhering to post-care guidance. That's no easy feat without a central data repository and analytics capabilities.

How CLM automation can help

The benefits of automation are well-established in modern business, and the healthcare sector is no exception. According to our panel of experts, automating CLM in value-based care arrangements overcomes some of the challenges we’ve outlined above by:

• Improving data consistency: CLM keeps contract terms and patient data aligned across systems.
• Reducing administrative workload: CLM automatically integrates multiple data points from different systems. This minimizes manual errors in data entry and contract reviews while freeing internal teams to focus on strategic initiatives.
• Advanced process automation: CLM enables automated approval requests, dynamically generated drafts, and pre-approved clauses.
• Streamlined payment processes: Automated workflows support faster and more accurate payment cycles.
• Ensuring adherence to compliance rules: CLM automatically tracks regulatory and contractual requirements, reducing risk.
• Accelerating decision-making: CLM automation delivers instant access to structured contract data for timely insights. More time can be spent on creating better programs and adjusting programs as needed at renewal time based on results from the prior year.

The building blocks of a future-proof CLM process

Where should providers and payers of healthcare services seeking to advance on their value-based contract automation and optimization journeys begin? Tom Cowen, Head of Healthcare & Life Sciences at Conga, says organizations should start by identifying quick wins. “Automating common, high-volume tasks like contract renewal reminders is a great place to start. Equally, standardizing key clauses and implementing a clause library will result in faster contract creation and improved consistency.” To build momentum, Cowen recommends that organizations also consider:

• Digitizing contracts: Centralize all contracts in a digital repository for easy access and tracking.
• Automating all contract-related workflows: Set up automated workflows for approvals, renewals, and compliance checks to realize immediate efficiency gains.
• Using predictive analytics: Leverage analytics to forecast risks, performance trends, and compliance gaps.
• Conducting regular training: Regularly train the system and your employees to ensure they stay updated on new contract types and regulations.

Scaling for growth with advanced integration with downstream systems

Once organizations have realized baseline wins, our panel suggests integrating contract data with downstream systems to further enhance care delivery and patient experiences. Tight integration will provide opportunities to:

• Enhance care delivery quality: Unified data enables care teams to make informed, timely decisions.
• Reduce errors in billing and payments: Streamlined data flow minimizes manual entry errors.
• Improve data consistency: Contract terms and patient data are aligned across systems.

When it comes to selecting which systems to integrate, our panel proposed starting with existing EHRs, billing systems, and care management platforms for the following reasons:

• EHRs: Ensures contract terms related to care quality and outcomes are visible to providers.
• Billing systems: Automates contract-driven billing processes, ensuring accurate and timely payments.
• Care management platforms: Aligns patient management with contract requirements, enhancing care coordination.

What’s the role of AI in value-based care contracting?

Nate Begani, Executive Vice President of Customer Success at Virsys12, explains that legacy data represents one of the biggest challenges in contract management, specifically migrating contracts from outdated systems to more modern ones and extracting metadata.

“AI and machine learning make these tasks far more manageable as they can read through hundreds of thousands of contracts and extract and integrate key metadata, clauses, and tables into a central digital repository in a fraction of the time it would take a person,” he says.

“Another important aspect is AI’s ability to find trends in data that humans might miss. With a robust CLM data model, you can leverage AI to surface key insights. For instance, Virsys12 has developed a solution that can compare multiple data sources, identify differences in provider data that may affect contract terms or payments, and flag those differences for review.”

Cardinell adds that AI also has valuable use cases in claims and rebate management. “By automating processes, it can build deeper trust between payers and providers and reduce the number of errant claims—and their associated costs.

Your next steps

Value-based care contracts have the potential to transform healthcare, but managing these contracts comes with its own set of data-related challenges for both payers and providers.

CLM solutions are proving to be invaluable tools for organizations seeking to navigate the complexities of value-based care. Whether you’re a payer or provider, you can realize compelling gains in care quality and patient outcomes and lower your administrative burden by:

• Digitizing your contracts to identify inefficiencies
• Integrating CLM with existing systems for better compliance tracking
• Using AI to transform unstructured contract data into actionable insights

Closing thoughts

Our panel shared some closing thoughts and advice for organizations seeking to address the complexity of value-based care contracts by capitalizing on advancements in CLM technology:

It’s a journey.

Don't let complicated use cases hold you back.

Remember, it’s all about doing the right thing for patients.