Our alternative payment models (APMs), formerly known as value-based agreements (VBAs), allow us to collaborate with providers to improve member health outcomes through payment incentives that promote higher-quality, affordable care rather than the number of services provided. We collaborate with providers to deliver care aligned with Quadruple Aim outcomes:
- Reduce costs
- Improve care quality
- Create a better patient experience
- Enhance provider engagement and experience
Our APMs are designed to meet providers where they are in their journey toward population health management based on each provider's unique strengths, capabilities and opportunities.
The PRIA platform is a new self-service business intelligence and analytics platform that:
- Includes timely patient-level data
- Unifies and simplifies access to multiple data sources
- Offers interactive dashboards and self-service reporting
PRIA helps you create and execute data-driven population health management interventions that improve quality while reducing total cost of care.
Offered free of charge to providers on APM arrangements with 1,000 or more attributed members.
For individuals: Better quality of care and health outcomes as well as improved satisfaction and lower premiums over time.
For providers: Access to shared data and technology to see a 360-degree view of each patient’s care history; channels to share best practices with peers; support and resources to transform provider practices; and the opportunity to earn financial rewards.
For employers: A shift away from unsustainable year-over-year cost trend increases with no promise of improved quality; better coordinated care for employees; and employees who actively participate in their health, which can reduce absenteeism.
This name change reflects our journey with health care payment innovation over the past 10 years. Over this past decade we’ve been able to connect to thought leaders in value-based care—physician champions and leaders from think tanks to other health plans. We’ve seen terminology shift as payment innovation has evolved. We are adopting "alternative payment model" as our term for any non-fee-for-service payment model, and the accompanying partnerships we enter into with willing provider groups. We’ll continue to use the term "value-based care" to refer to how physicians practice when APM incentives are in place.
Patient attribution is a critical part of VBAs, and defines the member population for whom a provider is accountable as part of a VBA.
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Note: Applies to the commercial Total Care Program and the Accountable Health Network agreements that are based on a target expense per member per month methodology.
Risk adjustment tools are used to risk adjust claims payment levels to reflect the underlying health status of a Provider’s Member population. Tools chosen for each year are consistently among the most accurate risk adjustment tools in the marketplace, as reported in industry studies and validated for Asuris data.
2023 and 2024 Risk Adjustment: The Milliman Advanced Risk Adjusters (MARA) tool will be used to risk adjust claims payment.
Concurrent (as opposed to prospective) risk scores will be utilized. Concurrent risk scores adjust for expected claims in the period being measured, rather than predicting future claims. Concurrent risk scores are generally more accurate than prospective risk scores and better adjust for year-over-year market fluctuations (e.g., pandemic flu).
Value-based care is focused on the quality of services delivered, where performance is evaluated on meeting target quality performance measures. Our Quality Program applies to Commercial Total Care and Accountable Health Network agreements.
Learn more about our Quality Program
Our Quality Measures Guide (PDF) provides more information on measure specifications and gap closure criteria.
2024 Quality Program: Final Date to submit Supplemental Data
- Chart note submission deadline
- Last day of February, 2025
EMR submission deadline
- Last day of February, 2025
You are encouraged to submit supplemental data prior to the last day of February. This will allow you to see your accurate quality performance to be reflected in reporting earlier. Also, please submit supplemental data for all Asuris patients in your care when possible.
We are introducing a VBR program as a component of our standard reimbursement methodology, effective October 1, 2023. This program incentivizes providers who deliver high-quality and cost-efficient care to their patients. Eligible providers scoring well among their peer groups in their specialty will earn higher reimbursement rates the following year. The first performance-based adjustment will occur beginning on October 1, 2024, based on performance in calendar year 2023.
Our VBR program consists of three key elements:
- Provider scoring: Data for specialty-relevant metrics are benchmarked against peer groups within the same specialty.
- VBR level assignment: Scores are arranged into specialty tiers— Level 1, 2 or 3.
- Reimbursement: Those assigned to the higher VBR level earn higher-than-standard reimbursement for most MD/DO services.
The VBR program metrics are specific to the following specialties:
- Dermatology
- Family Medicine and General Practice
- Internal Medicine
- Obstetrics & Gynecology
- Ophthalmology
- Psychiatry
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