Navigating the Value-Based Care Minefield: How RevOps Health Helped Challenge a $1.3M Risk-Sharing Penalty

Reading Time: 6 minutes
Financial Impact: Evidence provided to negotiate a $1M risk-sharing savings

After signing a Value-Based Care (VBC) contract with Anthem, a statewide OB practice was blindsided by a $1.3 million downside risk penalty, with no way to validate the payer’s claims. Anthem presented its cost calculations as final only in summary form, likely assuming the practice lacked the tools to analyze the data. Without RevOps Health, the practice would have been forced to either accept the charge or engage in an unstructured, “he said, she said” debate. Using advanced search capabilities and financial modeling, they extracted visit data, applied payer exclusions, and benchmarked costs against medical inflation. Armed with clear evidence, the practice countered Anthem’s assertions, proving that cost increases were primarily facility-driven and outside their control—leading to a major reduction in financial liability.

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