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Novel Payment Models for Specialty VBC Models with Accorded & Oshi Health

An overview of novel payment models for specialty value-based care during a Health Tech Nerd’s Lunch & Learn. 

In a recent webinar with Health Tech Nerds, we brought Frank Cheung, Co-Founder & CEO at Accorded, and Mike Goodman, Co-Founder & Head of Strategy & Operations at Oshi Health, together to talk about how Accorded makes it easier to understand and use value-based contracts for new specialty healthcare models. In this lively discussion, Frank and Mike walk through a case study from Oshi Health that demonstrates their unique GI care model. We’ll recap the key takeaways in this blog.

Read along for key takeaways or watch the full webinar here:

Intro to Value-Based Care

The webinar started with a review of value-based care (VBC) in primary and specialty care, emphasizing its importance in healthcare. Even though there’s been progress in implementing VBC in primary care, primary care only accounts for 30% of healthcare spending. To address the remaining 70%, specialty care models are essential. Many of these care contracts still operate under Fee-For-Service (FFS) arrangements.

What Is Specialty Care?
Specialty care is any care outside of the primary care domain. This involves medical services provided by specialists focused on specific areas of medicine. These specialists offer in-depth care for patients with conditions like diabetes and cancer, including diagnostic tests, treatments, and ongoing condition management.

3 Challenges in Specialty Care

Frank Cheung, Co-Founder & CEO at Accorded, outlined three big challenges that specialty care teams face when adopting VBC contracts:

  1. Payer contract terms that don’t reflect the value of a unique clinical solution
  2. Burdensome administrative overhead makes it difficult to justify the ROI of shifting to VBC
  3. Translating the intricacies of a novel or complex care model into a financial model

Frank emphasized the need for a comprehensive approach in reimbursement models to better define specialty care.

Varieties of Value-Based Contracts

Frank gave a high-level overview of the diverse contract forms existing in specialty care, ranging from Fee-for-Service (FFS) to Global Capitation. The varied contract types stem from the absence of a standard reimbursement method for specialty care, attributed to the diversity of specialty care models.

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4 Key Tenants of GI Claims Analysis

Next, Mike Goodman, Co-Founder & Head of Strategy & Operations at Oshi Health, provided insights based on Oshi Health's exploration of specialty care spending, leading them to develop their own methodology. To initiate the analysis of GI claims, Mike dove into 4 key tenants of GI claims analysis:  

  1. Take a comprehensive approach to capture relevant GI and GI-related spending
  2. Account for practice-driven coding variance when defining spending for specific conditions
  3. Isolate the GI care journey
  4. Acknowledge patients suffering in silence due to stigma and/or lack of sufficient care options

Mike then explained how Accorded’s actuarial platform facilitated analysis processing and standardized methodologies across diverse populations, which streamlined their contract negotiations with payers.

How Oshi Health Leverages Accorded

Accorded helped Oshi harness actuarial and data expertise for service cost benchmarking and episode of care analyses. With Accorded, Oshi can demonstrate significant savings opportunities to payers through deeper-level, population-specific claims analyses for the GI population and care journey. Together, Oshi and Accorded craft a compelling financial narrative in healthcare.

Related Reading: Oshi Health: Actuarial Intelligence for Strong Financial Value

Bottom Line

Accorded empowers you to accelerate your value-based care strategy by combining actuarial expertise and modern data engineering. With our platform, you have everything you need to execute a value-based care strategy. This includes:

  • Dedicated actuarial & med econ support
  • Access to 1B+ reference claims across commercial and Medicare datasets
  • Actuarially enriched data integrated with your existing tech stack
  • And more!

Meet with an expert and join forces with Accorded.

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