3D leaves

Tuesday, October 12, 2021
1:00 PM Eastern

In an effort to curb an unsustainable spending trajectory and improve patient outcomes, our healthcare system is steadily transitioning its reimbursement structure away from fee-for service (FFS) payments to value-based models. Healthcare systems are entering into value-based contracts with payers that incentivize improved patient outcomes and conscientious spending. Laboratory data is an often overlooked source of information that can be valuable in contract negotiation and patient risk documentation.

Alongside this change, laboratories are redefining their value proposition to ensure their services align with their organization’s value-based goals. One of the ways that a laboratory increases its value to patients and its parent healthcare organization is by providing data that supports organizational efforts in value-based contracts (VBCs), such as those in the growing Medicare Advantage (MA) plans. The laboratory can extract and present key data that identifies and measures the health of chronically-ill patients for quality metrics required by value-based contracts.

The webinar will discuss healthcare’s payment model progression as it relates to value-based contracts and define the value of laboratory data in proper documentation of patient status and risk. As a subset of VBCs, Medicare Advantage risk-based contracts will be discussed including an introduction to code sets that are used to predict healthcare spending based on patient diagnoses; and quality measurement systems that are used to measure quality of care. The laboratory’s “value-add” by contributing data to VBC performance along with specific relevant examples will be a key takeaway for attendees.

Learning Objectives:

  • Illustrate healthcare’s payment model progression—from fee-for service to fully-delegated risk as it relates to value-based contracts.
  • Outline the role of laboratory data in successful payor contract performance and in proper documentation of patient health status and risk.
  • Explain how laboratory data applies to quality performance metrics.
  • Appraise the value that point-of-care testing and metrics bring to value-based contracts, including specific data mining examples.

About the Speaker

Picture of Matt Modleski

Matt Modleski
Executive VP, Business Development
Orchard Software

As Executive Vice President of Corporate and Business Development at Orchard Software, Matt is responsible for strengthening Orchard’s corporate relationships and bringing additional value through new business opportunities. Previously, Matt led the operation of more than 70 physician practices and was a key member of the executive team at American Health Network. From 2006 to 2014, he was a partner at Stovall Grainger Modleski, a healthcare consulting firm with expertise in the healthcare environment and competitive positioning. Prior to his work in healthcare sales and marketing, Matt was an accomplished pilot in the U.S. Air Force. He was awarded the 355th Wing Instructor Pilot of the Year and also a lead member of the United States Air Force Air Demonstration Squadron, The Thunderbirds.