provider alignment
DESCRIPTION
Overview of provider alignment and loyalty programs- consulting services availableTRANSCRIPT
1
Provider Alignment & Loyalty Programs
Providers as Business Partners
2
Business Partner Imperatives
Ensure a stable healthcare delivery platform
Finding common goals Establish accountability Communicate clearly
and often Measure performance Reward performance
3
Provider Alignment Strategies
Mutual interest for all stakeholders (provider, payer, member/customer)
Requires contract terms and conditions that are explicit
Program policies must be reasonable and transparent
Pay for performance standards with clear cut goals and outcome measures
4
Pay for Performance Methods
Clinical Measures– HEDIS/NCQA– Specialty treatment
protocols– AHRQ Community
Quality Measurement Administrative
Measures– Contract compliance– Member satisfaction– Claims submission
5
Shared Savings Programs
CMS approach (“accountable care organization”)
– Savings as determined by per capita cost of assigned membership vs budget
Commercial payer approach– Similar but adjusted for plan
design and network features Medicaid approach
– More specific to HEDIS(e.g. Pennsylvania Medicaid model
All approaches require understanding and buy-in
6
Provider Loyalty Programs
Establish brand recognition among competitors
Build long term relationships
Foster health plan membership through referrals
7
Provider Loyalty Programs Continued
Opportunities for business exchange:
– Advisory councils for ideas and feedback
– Co-marketing of programs and services to other clients
– Co-sponsor consumer health education and improvement programs
– Continuing education programs
– In-kind consulting services
8
Provider Loyalty Programs Continued
Communication Strategies- Dedicated professional
services agents- Web page portal
Program policies Provider newsletter Other health care
information links
˗ “Fax Blast” Important program
notices Education events
9
Contact Us
Eagle Run Managed Care, LLC– http://www.eaglerunmcc.com– 937-350-5457
25 years managed care experience