Healthtech, care management, VBC, payer-facing, and provider enablement teams
Payer Strategy and Value-Based Care
Payer and value-based-care strategy linking reimbursement, contract economics, care delivery and evidence to a defensible funding decision.
Read the operating briefFrom payer pain to a defensible funding case
- Name the urgent payer problem
Frame cost, quality, access, care gaps, and operational feasibility.
- Separate proof from assumptions
Build a value-realization model with explicit opportunity ranges.
- Prioritize launchable accounts
Compare buyer pain, economics, partner fit, and implementation burden.
- Support the funding decision
Present reimbursement logic, proof gates, and executive-ready value materials.
The buyer problem
Show who pays, who benefits and who delivers.
I underwrite the purchaser’s value and the provider’s economics separately, then reconcile the contract between them. Lower medical spending, better access and stronger provider contribution are different objectives; they may not accrue to the same organization or within the same period. The partnership must name the funded population, attribution rules and party responsible for delivery risk.
The product may create value, but the buyer does not yet see the economics, reimbursement path, proof gates, or implementation model clearly enough to act.
What gets built
The deliverables and the handoff.
The work produces a contractable service model, a payer-specific economic case and an evaluation plan with a credible comparison. Expected savings remain assumptions until supported by evidence; funding for care delivery and working capital must remain viable while that evidence develops.
- 01
Payer-facing narrative around cost, quality, access, care gaps, and operational feasibility.
- 02
Value-realization model that separates verified proof from assumptions and opportunity ranges.
- 03
Account and partner priorities based on the buyer's problem, contract economics and readiness to deliver.
- 04
Executive materials that help CEOs and CFOs decide what to fund next.
Proof patterns
What leadership should be able to observe.
- 01
VBC contract logic across payer/provider contexts.
- 02
HEDIS/Stars, RAF/HCC, CMS-HCC V28, Managed Medicaid, Medicare Advantage, CKCC/KCC, and care-gap economics fluency.
- 03
Claims-informed opportunity mapping converted into provider and service-line decisions.
Decision questions
What the executive room must answer.
- 01
Which payer pain is urgent enough to create action?
- 02
What value proof will survive CFO scrutiny?
- 03
What implementation burden could block the sale after agreement?
Trust boundary
Conditions for responsible delivery.
- Do not pitch value-based care without a measurable proof path.
- Do not blend Medicare ACO economics with Medicaid or HRSN value without labeling the lens.
- Do not assume every mission-aligned partner is financially launchable.
Connected context
Follow the system beyond this mandate.
Discuss the mandate