How do you design a value-based digital health reimbursement model?

2 Identify your reimbursement pathway

The next step is to identify your reimbursement pathway: how will you get paid for your digital health solution? There are different types of reimbursement models, such as fee-for-service, capitation, bundled payments, shared savings, or pay-for-performance. You need to understand the advantages and disadvantages of each model, and how they align with your value proposition and the incentives of your payers and providers. You also need to consider the regulatory and legal requirements, the evidence and data standards, and the contracting and negotiation processes involved in each model.

3 Design your reimbursement structure

The third step is to design your reimbursement structure: how will you set the price, payment terms, and risk-sharing arrangements for your digital health solution? You need to balance the trade-offs between maximizing your revenue potential, minimizing your financial risk, and creating value for your customers and users. You also need to account for the variability and uncertainty of the outcomes and costs of your solution, and how they may change over time or across different settings and populations. You need to design a reimbursement structure that is fair, transparent, and flexible.

4 Engage your stakeholders

The fourth step is to engage your stakeholders: who are the key decision-makers, influencers, and end-users of your digital health solution, and how will you communicate and collaborate with them? You need to map out your stakeholder landscape, and understand their goals, preferences, and concerns. You also need to establish trust and credibility, and demonstrate the value and feasibility of your solution. You need to engage your stakeholders throughout the design, implementation, and evaluation of your reimbursement model, and seek their feedback and input.

5 Test and refine your model

The fifth step is to test and refine your model: how will you validate and optimize your reimbursement model in the real world? You need to pilot your model in a small-scale or controlled setting, and collect and analyze the data and evidence on the outcomes and costs of your solution. You also need to monitor and evaluate the performance and impact of your model, and identify the gaps and challenges. You need to test and refine your model based on the data and feedback, and make adjustments as needed.

6 Scale and sustain your model

The final step is to scale and sustain your model: how will you expand and maintain your reimbursement model in the long term? You need to plan for the scalability and sustainability of your model, and consider the factors that may affect its adoption and diffusion. You also need to leverage the best practices and lessons learned from your experience and from others in the field. You need to scale and sustain your model by creating a culture of continuous learning and improvement, and by fostering a value-based digital health ecosystem.

7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?