Business Implementation

Business Implementation

Successful value-based care programs require new processes and significant changes for many stakeholder groups. Focus on business readiness is as, or more, important than the deployment of technical capabilities for successful program deployment.

Related:

  1. Program Strategy
  2. Core Operational Capabilities
  3. Business Implementation
  4. Delivery Excellence

Business Implementation

Operational readiness – Payer

Health plans must ensure operational units are trained and prepared for new VBC program technology and processes, and that up front configurations and connectivity are established with participating providers prior to program launch.

How we can help

  • Business process readiness – we identify likely change impacts in operating models, roles and responsibilities, and business processes as current state operations are assessed against future state needs.
  • Pre-launch operational readiness plans – we collaborate with our clients to define operational readiness plans and checklists that can be used on an ongoing basis to prepare operational teams for provider onboarding to value-based care programs.
  • Post-launch operational readiness plans – we collaborate with our clients to define approaches to ongoing business process cadences, quality control procedures, issue resolution paths, ad hoc inquiry support and other factors to ensure teams are ready for ongoing operations.

Operational readiness - Provider

Health plans must collaborate with their provider partners to enable successful onboarding and adoption of new VBC programs.

How we can help

  • Provider contract execution support – we understand the steps that are necessary to support the provider in their transition to value-based care. We define and plan end-to-end provider experience strategies for value-based programs that support a provider’s program understanding of pre- contract through post-signature onboarding experiences, connectivity setup and ongoing business operations.
  • Program adoption strategies – we enable detailed initial program introductions and outline the goals and objectives of operational requirements, focusing on performance enablement program aspects (such as referral management) and roll out of successful provider training and education.
  • Creation of VBC program provider manuals – we help to plan and document critical aspects of the VBC program in a provider manual in order to enable program transparency, expectation setting and procedures to comply with program requirements.

Standard contract development

VBC programs often represent new contracting requirements for network management organizations.

How we can help

  • Coordination between multiple stakeholders – we support cross- collaboration of network, legal, and provider group teams in the development and approval of standardized contract templates and supporting materials (e.g. program manuals). Helping to ensure an end-to-end feedback loop from contract creation to signature for all stakeholders.
  • Support standard agreement language development – we assist in the development of standard VBC contract language to ensure clear and concise descriptions of program definitions, including aspects such as data sharing, clarity on the payment methodology utilized, and articulation of the valuation approach of the financial incentive models. This may include restructuring or expanding existing contracts to include VBC provisions.

Marketing and sales strategy

Marketing and sales engagement is an important aspect of communicating the strategic goals, expected outcomes and incentive techniques of a VBC program to the targeted customer base.

How we help

  • Construction of internal marketing and promotion tools – we can contribute program specific content to communications materials that showcase program benefits and help provide context into the overall vision and/or advantages of value-based care programs.
  • Creation of external marketing and sales tools – we support the creation of program specific content in marketing materials to outside provider groups, members, and employer groups that showcase value-based program objectives and positive impacts to cost and outcome.

Engagement of critical business units

VBC programs often involve collaborative design between multiple enterprise functions, including network management, care management and pharmacy.

How we help

  • Pharmacy business unit integration – we help to integrate incentive and quality aspects of program design across both medical and pharmacy domains to drive approaches that cover larger aspects of the overall cost of care.
  • Care management team engagement – we collaborate with care management teams in multiple ways, dependent on program design.
  • At a minimum, the expertise of care management teams should be a key contributor to program design, focused on data and insight sharing requirements and suggestions around provider care management approaches. As programs evolve to include delegation aspects or more collaborative operating entities, care management teams need to be involved in activities such as delegation oversight and joint operating committees.