Module 3
Value-Based Contracting in Commercial
The strongest published evidence for population-based payment is a commercial contract. Plus how quality gets measured without a federal program, and network design as the everyday lever.
By the end of this module, you will be able to:
- Summarize what the Alternative Quality Contract evaluation established and what it did not
- Explain how quality is measured in a market with no federal quality program
- Evaluate network and site-of-service strategies against the conditions they require
- Commercial Accountable Care The strongest published evidence for population-based payment comes from a commercial contract, not a federal model. Here is what it found and why. About 6 min
- Measuring Quality in the Commercial Market No federal agency sets quality standards for commercial plans. A private accreditor filled the gap, and its measure set became the industry's common language. About 5 min
- Network Design as a Lever Employers who cannot change prices can change who gets the volume. Network and site-of-service strategy is the most-used commercial value tool. About 5 min
Module quiz
Answer all questions to see your score.
1. What made the Alternative Quality Contract result unusual against the federal record?
Over eight years the initial cohort showed an 11.7 percent relative saving on claims with quality improving more than regional and national comparisons, in a peer-reviewed study with comparison groups.
2. Who sets the quality standards most commercial plans are judged against?
NCQA has no regulatory authority. Its influence comes from employers and states requiring accreditation in procurement, which turned a voluntary program into an effective requirement.
3. Where do most site-of-service steering programs fail?
A tiering scheme living in a benefits portal nobody opens is the clean example. Insight delivered outside the workflow does not change behavior.