Match provider networks with value-based care models, payer contracts

AlenaHeadshotHigh-performing provider networks aren’t built on luck. They take careful strategy and an accurate vision of how an organization will best perform under value-based reimbursement models. Providers chosen for a network will vary in performance and quality. Organizations should build networks with current contracts in mind, with long-term vision of its position on the risk continuum.

  • Fee-for-service with quality incentives – Focus on identifying high-performing primary care physicians and key specialists.
  • Gather accurate patient data and benchmark.Upside risk – Focus on coordinating with a narrow group of specialists to address costly and undertreated disease states within your population. Use data and analytics to identify at-risk populations.
  • Upside/downside risk and capitation – Share performance metrics to scale models by disease. Reward quality outcomes and cost effectiveness.

The key is to begin with the end in mind when choosing a high-performing, quality-minded network of health care providers. Download the Spring/Summer edition of Optum RISKMATTERS to view an infographic that illustrates how provider networks can match with fee-for-value contracts.


About the Author:

Elena White currently serves as Vice President of the Risk Quality & Network Solutions division for Optum. She has over 18 years experience leading network optimization initiatives, network development and expansion, business planning, provider reimbursement development, transformation to risk based arrangements and medical cost management strategies for both health plan and provider organizations.

Elena holds a Bachelor’s Degree from University of California at Riverside and Master’s Degree in Business Administration from Loyola Marymount University.

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