39AMGA.ORG NOVEMBER/DECEMBER 2018
Like a financial investor graduating from owning a single stock to managing multiple stocks or asset classes, the transition from managing a single value-based care (VBC) program to multiple programs requires a
new way of thinking and portfolio management approach.
It is now common for a provider organization to have five or
more programs in its VBC portfolio. The interwoven collection
of requirements, performance measures, and payment rules
gets increasingly complex to manage as the portfolio grows.
From the perspectives of provider organizations and
healthcare strategy experts, we examine four common
challenges and illustrate techniques and initiatives to help
manage multiple programs simultaneously without multiplying resources to do so.
An oft-seen artifact of an organization’s VBC portfolio is
“the grid,” a matrix of programs and performance measures.
The grid is the output—or simplified management tool—for
organizations struggling to get their arms around their VBC
portfolio. This tool weighs which (of the potentially tens
or hundreds) of performance measures apply to multiple
programs they manage.
One AMGA member describes a spreadsheet containing
21 programs and 54 measures across nine payers. Another
estimates 30 or more separate contracts represent the
tracking of at least that many measures. Yet another
describes “ 25 and growing” columns, representing only
those measures they could confidently track. Some creative
analysts enhance the grid to include measure performance
thresholds, financial impact ranges, or patient counts to
help draw useful comparisons among programs.
The grid serves as both a catalyst for discussion and
organizational change as well as a tool to give senior leadership a level of transparency. A large health system in New
York remarked that, prior to bringing the portfolio together
in one view, “it was very difficult to get the full picture of
even a single measure. There were silos everywhere.”
the Grid Managing your value-based care portfolio: lessons learned in the field
By Beth Houck and Tom S. Lee, Ph.D.