Value-Based Payment Roadmap to Risk
The ongoing affordability crisis in healthcare is compelling plans and provider organizations to shift away from traditional fee-for-service financing to the adoption of value-based payment arrangements.
Leveraging our extensive health plan experience, we bring valuable insights and experience to our provider clients as they look to take on increased risk across their patient portfolio. We understand the core capabilities and key success factors required to support provider organizations with this organizational transformation. HealthScape can help with:
- Market sizing and opportunity identification for risk-based models
- Organizational readiness assessment for risk assumption
- Value-based payment roadmap development
- Contracting support and analysis
- Health plan business case development, planning and socialization
- Enterprise change management to support value-based payment models
- Care improvement identification
- Clinical and financial measure development
Provider-Sponsored Plan Advisory
Having worked with over 25 provider-sponsored plans (PSPs) across nearly 60 engagements in 2018, we understand the unique needs and dynamics of PSPs.
HealthScape is a Preferred Business Sponsor for the Health Plan Alliance, a leading professional association of provider-sponsored plans. Through this partnership, we have advanced our firm’s ability to not only provide expert consultation and advice, but also support implementation of critical strategies and tactics through execution of our recommendations. We bring marketing-leading intelligence and significant expertise in:
- Government market entry evaluation, strategic planning and operational support
- Response to regulatory changes and local market dynamics
- Operational and performance improvement
- Analytics, reporting and data management strategies
Enterprise Delivery Redesign and Support
Given the changing healthcare landscape, many health systems recognize the need to change their clinical and operating models to adapt and succeed in this new environment.
Many systems are contemplating sunsetting all or select inpatient operations, adapting their compensation models, evaluating new partnerships, and / or making facility or other operating model changes.
Our team is comprised of seasoned experts who can support the considerable level of change management required to make these clinical, operating, and organizational model changes. Our work has included the following strategic initiatives:
- Financial modeling of the implications of service shifts (e.g., inpatient / outpatient, site of care)
- Support of inpatient hospital closure and related service transition
- Clinical program and facility strategies to support value-based transition and financing models
- Evaluation of the role and responsibility shift between delivery system and the health plan required for this transition
- Utilization and cost analytics
Integrated Revenue Cycle
The financial opportunity cost of incomplete and inaccurate coding has a larger material impact on providers than it does on insurers.
An integrated revenue cycle helps create transparency and coordination between providers and insurers to ensure revenue accuracy. In concert with our sister company, Pareto Intelligence, our team helps providers drive accurate premium revenue capture from private payers, CMS and state governments. We help providers:
- Close risk documentation gaps in the risk adjustment process
- Complete and accurate data transmission and submission across all stakeholders
- Verify accuracy of patients’ Medicare Secondary Payer (MSP) and entitlement classification for accurate capitation payments