Case Study

Behavioral Health Provider Implementing Multiple VBC Contracts



A behavioral health organization needing value-based contracts implemented across multiple states to ensure contract compliance and revenue realization.

Client Pain Points

  • Little to no expertise in implementing value-based care (VBC) contracts.
  • Revenue loss from implementation.
  • Payers’ credentialing and claims systems along with inexperience in behavioral heath value-based care created non-payments and issues.

CWH Solutions

  • Implemented a new payer function to establish relationships with key payer roles and met quarterly to review results; set up operational contacts.
  • Created value-based models (bundles, synthetic bundles, risk bearing bundles, and hybrid bundles) to higher revenue impact. Components included: service requirements, encounter reporting, clinical set-up and claim rules for revenue cycle management processing.
  • Created an analytics framework to evaluate cost impacts.
  • Created individualized contract models for over 90 contracts.
    • Allowed for claims to be created and billed correctly, including the ability to automate.
    • Highlighted minimum service requirements and documentation needed

CWH Delivering Value

  • Increased revenue run rate by 40% per month.
  • Demonstrated members had less Emergency Department utilization and reduced cost of care over three year.