Value-Based Risk Bearing Care & Care Mgt Capabilities

01/25/2022 Collected, modified by Valmeek Kudesia; blatantly inspired from Ian Chiang, FlareCapital

Technology Infra & Pop-Health Management Tech


Enterprise data architecture and data aggregation

  • Data integration and exchange (including interoperability)

  • Risk stratification and population health analytics

Data analytics and reporting/presentation capabilities

  • Automated

  • Self-service

  • reflection to [[data-omnivorous-platform-healthcare]]


Care management and care coordination solutions


Member/patient engagement solutions


Business intelligence and analytics capabilities

  • Operational performance

  • Value-based contract management


Contract-level analytics capabilities for TCOC analytics

Pop Health, Care Mgt, Patient Engagement, and Benefits Admin


Population health analytics & individual patient analytics

  • Risk adj/stratification

  • Predictive/prescriptive modeling


Clinician training and education services

  • Team-based care enablement

  • Evidence-based protocol education and adoption

  • Appropriate clinical documentation and education

  • Upskilling lower and mid-level clinicians

  • FFV/VBC value optimization services


Gaps in care/care gap closure

  • Stars management, P4Q

  • Performance and cost initiatives design+exec


Care management services

  • Case management, Care coordination (Medical+BH+SDOH)

  • Gap closure services and resource augmentation

    • Mbr+prov oriented programs

  • Collaborative care enablement

  • Transition-of-care (TOC)

  • Disease+complex care mgt (clinic, home, virtual)

    • Chronic conditions management

    • Behavioral health. Disease-specific

  • Medication therapy management, adherence, and reconciliation (in-office, at home or virtual)

  • Utilization management

  • Referral management and support

  • Other home-based care and care delivery services (as care extension)

    • Annual wellness visits

    • Chronic condition management (via telehealth and remote monitoring)

    • Palliative care

    • On-demand urgent care

    • Companionship/loneliness alleviation

    • Hospital-at-home

Value-added Admin, Network, Practice Mgt for [[all participants]]


Network construction, management, and operations services

  • Network strategy and optimization

  • High-performing specialist recruiting, contracting, credentialing (i.e., for multi-specialty IPAs and health systems)

  • Post-acute care network management

  • Community-based Social determinants of health (SDOH) network management

Health plan value-based contract Negotiation, Management, and Advisory


Population health management and value-based contract management education


Transformational services and training

  • Operations workflow redesign and enablement

  • Technology implementation, enablement, and adoption

  • Financial and business transformation


Practice Management services

  • Claims processing and/or claims payments if also payor

  • Revenue cycle management (RCM)

  • Scheduling and appointment management

  • Workflow (administrative) automation and digital assistance

  • Group purchasing services

  • Patient acquisition and multi-channel marketing services and management

  • Technology RFP and asset management


Incentive design


Analytics enablement/analytics-as-a-service


Member/patient services

  • Enrollment, eligibility maintenance

  • Call center operations

  • Health plan navigation and benefits education