Healthcare professionals meet to discuss creating, managing and enhancing network organizations

Value-Based Care: Network Organization

Helping healthcare provider organizations create, manage and enhance network organizations that deliver measurable value in both a fee-for-service and a value-based care environment. 

It is essential to look at your coordination activities across the entire care continuum to ensure it aligns with value-based contracting (VBC) requirements. Is your organization ready?

    Health plans want to work with providers that can deliver a full-service continuum of care. Patients want to be served by systems that take a more holistic approach to their health. In both a fee-for-service world and a VBC world, those with the most integrated and effective network organizations will succeed.

    Most health systems claim to provide a full continuum of care. However, our experience suggests that fewer than one in 10 actually offer the type of end-to-end, integrated network organization that is required to deliver on that claim. More often than not, provider care continuums are fragmented, narrow and delivered in silos. 

    As providers look to take on more upside risk in their pay-for-performance contracts, success will largely depend on the strength and value of their networks. Finding the right partners to work with takes time and advanced insight. Collaborating with them to develop the right systems, tools and metrics to create value in a VBC environment will require new capabilities and resources.

    Value-based transformation for healthcare providers

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    “In order to successfully assume more risk in contracting, you need a network that is fully aligned on value-based requirements and care coordination activities. You really need to have a single view of how your network will communicate with and manage the patient from ED to inpatient to outpatient clinic to home care.”
    David A. Gregory, Principal, Baker Tilly

    Five key considerations

    1. Expand the network: Start with a vision of an “optimal” end-to-end care continuum and evaluate your current network to identify gaps. Conduct a market scan of potential providers and identify the top players in your markets. Understand their readiness to take on risk in a VBC world and work with them to develop pay-for-performance models.
    2. Drive integration: Starting with your most important network partners, develop systems and tools that enable data sharing and coordination across the network. Recognize that there will not be a “one-size-fits-all” technology solution and build tailored integration plans that suit the unique needs and roles played by each partner. Go beyond systems and tools to integrate communication processes, governance and measurement.
    3. Focus on the data: Data is the lifeblood of a strong network organization. Patient data must flow easily across the network. Operational data must be harvested to drive improvements. Performance and quality data must be measured, integrated and reported. Throughout, access to data must be carefully managed to reduce cyber risks and to protect patient privacy.
    4. Develop internal capabilities: In order to build, manage and continuously improve a network organization, providers will need to develop new skills and capabilities, particularly around contracting, data management and analysis. The ability to properly assign risk and reward across the network organization will also require new skills and actuarial-type capabilities that few providers currently possess.
    5. Change management: Beyond linking up systems and sharing data, the development of an effective network organization requires new ways of working, new collaboration models and new roles and responsibilities. Change management requirements should not be taken lightly. Your physicians, administrators and key internal stakeholders should be active participants in welcoming change. 
    “If you want to be a market leader, build market share and get out in front of the competition; if you really want to be attractive to health plans and drive better patient engagement, you need to be focusing on expanding and enhancing your network organization. A stronger network organization will deliver value to providers today. It will also allow them to prepare for success in a world dominated by VBC models in the future.”
    David A. Gregory, Principal, Baker Tilly
    “The top health systems are not only focusing on building networks that will thrive in a VBC environment, they are also creating near-term value by leveraging their networks to capture new revenue streams and  contract directly with employers.”
    Michael Patti, Principal, Baker Tilly