Provider Network Development

Building a network that’s right for you.

Physicians, medical groups, health systems, hospitals and other providers such as federally qualified health centers (FQHCs) and behavioral health are recognizing the value in developing a network capable of contracting with payers and self-insured employers in financial risk arrangements. This ability to align financial incentives and gain access to savings and delegation of key services enables physicians and providers to create a much stronger total cost of care, quality, access and member experience value proposition for payers. In an environment focused on cost-cutting and improved outcomes, the ability to organize physicians and providers into a high functioning network is key to financial success.

Regardless of whether you are a group of independent physicians, medical group, hospital with physician network or large diversified health system, our team of experts will help you determine whether you should create a new provider network and/or payor contracting entity, optimize an existing structure, or consider a combination is the best fit solution for your needs.

Our team can assist with:

• Gap assessment for existing or potential new provider risk vehicle with relation to various key aspects such as network adequacy, management service organization (MSO) service requirements and value proposition or care model
• Development of a new provider risk vehicle, such as an IPA, ACO, PHO, etc, or optimization of an existing vehicle
• Legal and business structure design and implementation
• Governance design and optimization
• Network development and provider relations design, implementation and optimization
• Payor contract negotiations and performance improvement
• Care model design, implementation and optimization
• Data analytics
• Requirements development and build or buy decisions for MSO or population health management organization (PHMO) infrastructure and capabilities
• Design, application and implementation support, including adapting existing networks or provider risk vehicles / networks, for federal and state provider risk vehicle models such as Medicare Shared Savings Plan (MSSP) ACOs, All Payer ACOs (New York State only), Restricted Knox Keene (California only) and Medicaid waiver entities such as Texas’ regional health plans (RHPs) and New York’s performing provider systems (PPS)

 

Our Approach:

We partner with our clients to focus on the specific strategic and business goals they are working to solve and recommend the best solutions, rather than trying to fit physician groups, health systems or other providers into a “flavor of the month” model such as an MSSP ACO, IPA, etc.

With deep experience in helping numerous physicians, medical groups, health systems, FQHCs and others to create and optimize provider risk vehicles, our team is able to bring best practices and a set of proven models, pro forma, funds flow models and templates to bear.

Our team of experts have deep expertise creating and managing provider risk vehicles, as well as health plans. We know how to achieve desired outcomes and are able to target our current state assessment in order to quickly identify the gaps that need to be closed in order to achieve early success and build the foundation needed for long term sustainability.