How Partners HealthCare Manages Costs in At-Risk Contracts (HFMA)


Partners HealthCare utilizes an analytics infrastructure to 
manage risk and optimize value for high-need populations.

Risk-based contracting for population health management is grounded in simple math. Healthcare organizations that exceed total medical spending targets for these contracts absorb a penalty. Those that keep expenses below these targets create savings they can keep.

With multiple at-risk contracts in all major payer categories, Boston-based Partners HealthCare—the largest integrated delivery system in Massachusetts—is currently at risk for the costs of care for more than 500,000 patients. With so much on the line, medical expense management is crucial, especially for high-risk, high-utilization populations. Like most health systems, Partners does not lack for high-risk patients. Consider, for example, that a typical patient within the health system’s integrated care programs is 76 years old, is taking more than 12 active medications, and has more than three acute-care hospitalizations per year.

To hold increases in total medical expenses below the national average and meet other objectives in the new value-based landscape, Partners has implemented the following strategies and achieved progress in managing risk and optimizing value for at-risk populations.

Setting Performance Targets and Analytics

Leaders at Partners developed a framework to promote the best possible care for all patients while also meeting the demands of multiple contract requirements. The health system’s internal performance framework uses a single set of performance targets—called cost-standardized medical expenses—and a single incentive pool for all Partners contracts.

Within this framework, Partners needed to empower care teams … View Full Article Here