Cost reduction and performance improvement: Product networks
The challenge
A payer's livelihood, and the welfare of its members, depend on building a provider network that promotes member growth, retains high-quality providers and satisfies regulatory requirements. To accomplish these goals, the network needs to aggregate the right number and mix of providers and services, the right geographic distribution and the right incentives to give their members access to quality care at an affordable cost.
Cost and margin pressures, managed care, consumer demands and quality-linked payments exacerbate historically fractious relationships between payers and providers. Lack of clarity concerning contract terms can lead to reimbursement disputes. Inadequacies in administering contracts cause inaccurate and untimely claims payment, resulting in operational inefficiencies and consumer dissatisfaction. Bringing improved methodology to negotiating and administering provider contracts benefits all healthcare stakeholders.
How we can help you
You need to give your members access to a broad provider network that includes the physicians, hospitals and other resources they want to use. We can apply a tailored, systematic approach to help you identify and remedy inadequacies in your provider contracting and contract administration process. You should adopt new payment models such as pay-for-performance and value-based pricing, to assure the best quality and value from your network participants. We can help you devise suitable, measurable performance metrics, data collection standards and analysis methods and a collaborative governance model for managing and compensating network participants.Common services include:
- Designing broad, high-quality provider networks that attract and retain members
- Assisting in negotiating and administering provider contracts
Subject matter specialist |
