Risk-Readiness®, at its core, describes payers and providers that can successfully identify and manage the estimated 30% of spending that goes to unnecessary care. This unnecessary spend drives billing in a fee-for-service economic model, but success in pay-for-value comes from managing and mitigating these pockets of variation.
RowdMap’s Risk-Readiness® Benchmarks match physicians and physician groups to the optimal payment arrangements based on their collective practice patterns and the characteristics of their populations and geography. RowdMap’s Risk-Readiness® Platform helps plans and providers identify and manage risk-ready physicians to place into high-performing networks and to move into new arrangements with performance, and ultimately, risk components.
Commercial health plans have begun the transition to performance and risk-based contracting. By 2018, CMS will move 50% of Medicare fee-for-service payments to pay-for-value through a variety of risk-sharing arrangements. In these new models, network strength will be a strategic differentiator.
Newly released government data on providers has created a sensation on the evening news, but the real opportunity comes when payers and providers use it to take on and manage risk. Traditional targets of medical economics—such as utilization review, gap closure, and fraud and waste efforts—only go so far in managing risk. New challenges require entirely new approaches to risk management. Payers and providers can use RowdMap’s Risk-Readiness® Platform to understand provider practice patterns, population drivers, and deep care pathways necessary to succeed in a world where payers and providers share risk.
RowdMap’s Risk-Readiness® Benchmarks look at a different category of spending to shift focus from clinical edits, audits, and recovery efforts to identifying care that is clinically appropriate, but unnecessary. Historical efforts have shown returns, but they only look at a fraction of total spending. Unnecessary care can account for up to 30% of total spending and provides significantly larger opportunities for cost containment and quality improvement.
“It’s generally agreed that about 30 percent of what we spend on health care is unnecessary. If we eliminate the unneeded care, there are more than enough resources in our system to cover everybody.”
Dr. Elliott Fisher, Dartmouth Institute for Health Policy and Clinical Practice.
“Bigger than higher prices, administrative expenses, and fraud, however, was the amount spent on unnecessary health-care services.” In just a single year, up to 42% of patients receive “Low Value” Care.
Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard School of Public Health & the Department of Surgery at Harvard Medical School.
The American Medical Association and RAND published a study, "The Effects of Health Care Payment Models on Physician Practice in the United States," concluding that doctors need help moving from Fee for Service to Pay for Value.
Study lead Dr. Mark Friedberg explains to Forbes, “For many doctors and many physician practices, the desire to be paid a different way is there, but actually doing this is quite difficult." In a nutshell, "To do well with population health metrics, (doctors) had to develop a data infrastructure that they didn’t have. Those kinds of changes require major investments.”
RowdMap’s Risk-Readiness® platform, products and services are purpose-built to help health plans, government payers, providers, and hospital systems develop Risk-Readiness strategies to excel as they transition from fee-for-service to pay-for value. Payers and providers use RowdMap’s Risk-Readiness Benchmarks to intelligently participate in pay-for-value programs, negotiate with partners, and profile physician performance.