Network design and optimization
To help increase financial efficiency of healthcare expenditures while increasing quality of care, it is paramount to match your program with an appropriate healthcare provider network and incentivize that network appropriately to maximize the quality and value of care. Baker Tilly can help your organization build and optimize an effective provider network strategy, including:
- Network creation and refinement: Forming a network that covers all CMS-covered service categories, including “CMS adequacy,” as well as special relationships with subset of providers beyond adequacy.
- Identification, evaluation and prioritization of provider candidates: Beyond building base provider networks, supporting the identification and evaluation of which providers to target for value-based care (VBC) programs; prioritizing provider candidates based on a variety of considerations (e.g., provider risk readiness, network and market impacts of selection, stakeholder feedback and requests, and program level requirements); and identifying opportunities to more closely align MA reimbursement with CMS premium cost drivers.
- Risk readiness assessments and improvement strategies: Administering provider risk readiness assessments and formulating collaborative improvement strategies with both health plans and healthcare providers.