For Provider Organizations/Accountable Care Organizations:
A recent trend involves health care providers who wish to provide health insurance options that compete with traditional health plan carriers. The ACO has the expertise in managing the health of their patients and are gaining in the expertise in the offering and administration of health insurance products. One advantage of such an offering is to drive increased utilization of the ACO providers. This not only increases volume at these providers but also puts more of the patient care within the control of the ACO thus enabling better overall patient management.
The RiskVantage team has significant experience working with providers in developing reimbursement models with health plans to drive efficient and quality care. Analysis is essential for the ACO to understand the performance of their physicians partners to identify areas to improve patient care. Often, an ACO will need to partner with additional, non-affiliated, providers to develop an adequate network within the geography they wish to conduct business. RiskVantage can help assess providers to bring together a high quality network.
To support development of ACO health plan offering, RiskVantage can help in a variety of ways:
1) Design plan offerings that incent members to utilize efficient ACO providers
2) Regulatory reporting
3) Go to Market assessment and strategy
4) Identification and evaluation of Stop Loss Carriers for self-funded offerings
5) Evaluation of Pharmacy Benefit Manager proposals for self-funded offerings
6) Structure of wellness programs
7) Population health management to stratify members and identify at risk patients for priority clinical interventions
RiskVantage also can provide additional services to support provider organizations. The RiskVantage team has extensive experience working on behalf of health plans in negotiating reimbursement with large physician, hospital and ancillary vendor contracts. These contracts include fee for service reimbursement, capitation and risk sharing models. The complexity of the methodology used for shared risk contracts has increased significantly as advanced analytics have been developed to attempt to distinguish performance of one physician versus another. The RiskVantage team has collaborated with providers to develop these models and has experience overseeing the implementation of these models within health plans. RiskVantage can model the financial impact of health plan proposals and assist in negotiation with health plans.
RiskVantage is available to consult with providers when contracting with health plans or can be called upon to analyze the data provided by health plans reporting the reports of existing shared risk models.
