Distinguish pay-for-performance, shared savings, capitation and bundled payment on risk transfer.
Healthcare & Pharmaceutical Management
Value-Based Care Contracting and Bundled Payment Design
Prepares payer and provider leaders to design value-based contracts and bundled payments that link reimbursement to cost, quality and patient outcomes.
🗓️Duration5 training days
📚Content4 modules · 8 sessions
🎓On completionAccredited attendance certificate
About the programme
Course Overview
Payers and providers increasingly move reimbursement away from volume-based fees toward contracts that tie payment to the cost and quality of an entire episode of care, but many organisations sign these arrangements without the data infrastructure or care redesign needed to perform under them. This course compares pay-for-performance, shared savings, capitation and bundled payment models against their risk transfer and data requirements, then works through designing a bundled payment: defining the episode trigger and window, setting a target price from historical cost baselines, and building quality gates that protect patients from stinting on care. It covers the payer-provider negotiation itself, including actuarial analysis, risk corridors and gain-sharing rules, and the care redesign, physician alignment and coordination structures needed to deliver against the contract. The final module addresses monitoring performance, reconciling payments and using contract history to negotiate the next cycle. Teaching uses target-price models, quality gating structures and contract term sheets drawn from real payment reform programmes. Participants leave able to design, negotiate or operate a value-based contract with confidence in its financial exposure.
Expected Learning Outcomes
Specify the data and attribution rules needed to monitor a value-based contract accurately.
Define an episode trigger, time window and target price for a bundled payment arrangement.
Design quality gating measures that link reconciliation payments to patient outcomes.
Prepare the actuarial analysis that supports a provider's position in contract negotiation.
Redesign care pathways and physician compensation to perform under a value-based contract.
Reconcile contract performance against target price and quality thresholds each settlement period.
Who Should Attend
Payer contracting and network management staff negotiating value-based arrangements.
Hospital and health system finance leaders assessing risk-based payment contracts.
Population health and care management directors implementing bundled payment programmes.
Actuarial and analytics teams modelling target prices and risk corridors.
Physician group leaders aligning compensation with value-based incentives.
Accountable care organisation executives managing shared savings performance.
Course Modules
Select any module to see its sessions and points.
01Foundations of Value-Based Contracting Models
2 sessions · 8 points
Session 1Comparing Value-Based Payment Models
- Distinguish pay-for-performance, shared savings, capitation and bundled payment on risk transfer.
- Assess organisational readiness for upside-only versus two-sided risk arrangements.
- Evaluate accountable care organisation structures and their patient attribution methodologies.
- Select a value-based model that matches the organisation's data maturity and risk appetite.
Session 2Data Infrastructure and Attribution
- Specify the claims and clinical data feeds needed to monitor a value-based contract.
- Apply attribution rules that assign patients to the accountable provider or care team.
- Build risk-adjustment methods, including condition-based case-mix weights, into performance analysis.
- Identify data gaps that would prevent accurate reconciliation under the proposed contract.
02Designing the Bundled Payment
2 sessions · 8 points
Session 1Defining the Episode and Target Price
- Define the episode trigger, time window and included or excluded services for the bundle.
- Set the target price using historical cost baselines adjusted for case mix and trend.
- Build outlier and stop-loss provisions that protect providers from catastrophic episode cost.
- Model provider financial exposure under the proposed bundle across a representative caseload.
Session 2Linking Payment to Quality
- Select quality gating measures, such as readmission rates or patient-reported outcomes, for the bundle.
- Set thresholds that link reconciliation payments to quality performance rather than cost alone.
- Design safeguards against stinting on care or inappropriate case selection under the bundle.
- Align internal quality reporting with the measures specified in the payer contract.
03Negotiating and Implementing the Contract
2 sessions · 8 points
Session 1Payer-Provider Contract Negotiation
- Prepare the actuarial and utilisation analysis that supports the provider's negotiating position.
- Negotiate risk-sharing corridors, stop-loss thresholds and reconciliation timing with the payer.
- Align contract terms with regulatory requirements governing fraud, abuse and gain-sharing.
- Finalise the contract's data-sharing, audit and dispute-resolution provisions.
Session 2Operationalising Care Redesign
- Redesign care pathways and discharge planning to manage the full episode of care.
- Align physician compensation models with the incentives created by the value-based contract.
- Establish a care coordination team responsible for post-acute and transitional care management.
- Train clinical and administrative staff on their role in delivering the redesigned pathway.
04Performance Monitoring and Contract Evolution
2 sessions · 8 points
Session 1Monitoring Financial and Clinical Performance
- Track episode cost, utilisation and quality performance against the contracted target price.
- Reconcile actual performance against target price and quality thresholds at each settlement period.
- Investigate cost or quality variance to identify care-redesign opportunities.
- Report value-based contract performance to clinical and finance leadership on a recurring cycle.
Session 2Renegotiation and Portfolio Strategy
- Use performance history to renegotiate target prices, risk corridors and quality thresholds.
- Assess readiness to move from upside-only to two-sided risk in the next contract cycle.
- Manage a portfolio of concurrent value-based contracts without conflicting incentives.
- Plan the transition of successful bundles into broader population health arrangements.
What the participant receives
4 course modules
A structured syllabus
8 training sessions
across 5 days
32 detailed points
Applied, detailed content
Accredited attendance certificate
On completing the programme
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