What does high quality, trustworthy V1C look like? Explore the IMPACT Core Competencies framework to discover what good V1C looks like and how to get there.
Core Competency: Administrative Efficiency
Minimizes implementation and operational frictions
V1C is a rapidly expanding field crowded with innovative first to market and fast follower solutions. The ability to execute–efficiently, consistently, and with clinical rigor–distinguishes the top companies from those who will not scale beyond an initial niche market.
Outstanding V1C entities are adept at balancing innovation and rapid cycle improvement with clinical and professional rigor. This enables them to attract and retain top clinical workforce talent, manage to market-leading quality, access and patient satisfaction targets, and adopt a flexible approach to partnering with health plans, other providers and employers.
Choose a stakeholder to see their perspectives on Administrative Efficiency.
Third-party payer deals and reimbursement is becoming critical to establish V1C as a new standard of care that is accessible at scale and is a natural progression for V1C solutions that may have started out in the direct-to-consumer market. Positioning for third-party payer contracts requires a clear understanding of the alignment between the payer’s systems and processes around new modalities of care.
To streamline contracting, it is important that contract discussions start with a shared definition of V1C solutions as healthcare providers as defined in federal regulations, and are thus Health Insurance Portability and Accountability Act (HIPAA)-covered entities with the same obligations to patients as brick and mortar providers.
Ability to submit claims to insurers or third-party administrators (TPAs)*, regardless of desired payment model (fee-for-service, bundled payment, or risk-based) to facilitate analysis and explicit tracking
- Flexibility in collaborating with partners to optimize coding and payment structures
Ability to collect payments for member responsibility in a secure, efficient way, with satisfactory member experience
Willingness to enter into fee-for-service arrangements as an on-ramp to more complex contracts if necessary
Positioned for outcomes-based arrangement (e.g., performance guarantees)
Positioned for entering into 2-sided risk-sharing arrangements with payers and other partners
Marketing and outreach processes and materials–digital or otherwise– are HIPPA compliant and designed to safeguard against any transparent implication that enables entities other than the intended recipient to attribute a condition to the recipient.
- When promoting services in partnership with or on behalf of health plans or employers, use of the appropriate business associate agreements (BAA) and patient consent, when necessary
Proven record or logical pathway to identifying, reaching, and enrolling eligible participants
Ability to scale practice broadly:
- ‘50-state solutions’ are highly desirable for national health plans and large employers
- Credentialing process and documentation is compliant and auditable by partners
- Providers are credentialed in multiple states
Health coaches are certified by relevant specialized programs, e.g., CDC-recognized diabetes prevention program (DPP) coaches or Certified Diabetes Educators (CDEs).
Uses multifactor provider identity authentication
Provider model enables patients to interact with the same provider, if desired.
Adheres to well-documented practice guidelines aligned with evidence based clinical quality and safety standards
- Audits clinical practice against established care protocols and clinical guidelines (e.g., regular chart reviews) and can provide evidence of consistent quality and safety
- Protocols in place to document and manage adverse events
Ability to provide real-time feedback on performance to clinical staff as a complement or replacement for retrospective audits