As healthcare organizations move away from reimbursement models that reward volume and begin to accept financial risk based on outcomes, they may need to change the make up of their provider networks.
Explained another way: new contract demands require new network strategies.
But how do you make a change? You can start by understanding your end goal.
When organizations begin with a goal of becoming a high-performance network, they’ll focus on cost, quality, efficiency and patient satisfaction.
You need to take a look at whom you need in your network, why you need them in your network and ensure that you have the proper coverage from a geographic and specialty standpoint to meet the needs of your population. You need to understand your risk equation and why you’re including or excluding certain providers.
It’s also important to understand that a network won’t remain static. As providers move farther down the “risk continuum,” their provider needs will change.
By understanding the vision you have for your organization when fee-for-service reimbursement is no longer the main mode of reimbursement, you can design a provider network that will evolve with you.
Take five minutes to listen to a #5in5 podcast on this topic. You’ll learn about the four main types of risk and how your strategy might change as you move through each level.
You can further explore provider networking in the RISKMATTERS article Designing a Provider Network with Your Vision for Value-Based Care.
About the Author:
Jay Levine, MA, MBA, is the Vice President of Provider Population Health Management Solutions for Optum’s Consumer Solutions Group. He has over 20 years of experience supporting healthcare leaders and provider organizations in areas such as strategic planning, marketing, business development, physician practice management, and hospital operations.
Jay currently serves as a subject matter expert and strategic advisor to provider organizations establishing population health management capabilities to transition their clinical operations to a risk bearing entity. He has been featured in publications including Healthcare Executive and Healthleaders.com and presented at national conferences on the topics of healthcare strategy and marketing.