Provider Led Health Plans 202 - A Roadmap to Ensuring Financial and Clinical Sustainability
For the past 14 years, SCIO Health Analytics has supported health plans solve complicated problems simply and efficiently through services and actionable insights. During this time, we’ve witnessed the emergence of a new and promising type of organization, the provider-led health plan.
While much of the attention directed towards provider-led health plans is understandably focused on clinical alignment and the high quality of care delivered, successful entities must also ensure that their financial affairs are in order. However, according to a recent report by the Robert Wood Johnson Foundation, the majority of these organizations are operating at a loss; unless this trend is corrected, many health plans will be forced to close their doors.
We believe that there are two primary drivers behind these difficulties: an over eagerness to adopt value-based policies while the majority of reimbursement is still volume-based and a lack of familiarity with the reimbursement optimization programs like those developed over years by traditional health plans. We also know that with some deliberate actions in key areas, provider-led health plans can improve their financial situation while maintaining or even improving the quality of care received by their members.
In this webinar our experts discussed the critical concepts required for sustained financial success:
- Managing Risk and Revenue
- Network and Operational Optimization
- Improving Quality and Compliance
Rodger Smith, SVP, Payment Integrity
Jen Cressman, VP, Professional Services
Held on: September 21, 2017