“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
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.
Value-Based Care: Network Organization
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.
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.
Two minute self-assessment
Ask yourself whether …
- You have robust relationships with primary care services, post-acute services and other care organizations that allow you to deliver fully integrated and coordinated care across the entire care spectrum?
- Your existing network contains the right mix of services and providers to achieve a continuum of care that delivers value to patients, health plans and network partners?
- You and your network partners have the data, metrics and systems required to ensure all parties are delivering on expectations?
- You have a process for providing proactive preventative and chronic care to patients, both during and between encounters with the healthcare system?
- Your team has tracked the impact and results of treatments to determine which have the greatest measurable impact and should therefore be offered to the community served?
If you answered “no” to any of these questions – or if you just don’t know the answer – you may not be ready to assume the risk required to successfully move towards value-based care. Talk to us to find out how your organization can become ready.
“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
How Baker Tilly can help
Baker Tilly’s team of Value Architects™ provide management consulting, technology and financial planning for healthcare organizations across the health plan, provider and life sciences spectrum.
We understand the true value of a strong network organization and our professionals know what it takes to create a robust, integrated and effective continuum of care. From conducting market scans and competitive analysis through to supporting contracting, integrating technologies and assessing quality measures, Baker Tilly’s healthcare practice helps providers and health systems create, manage and enhance network organizations that deliver measurable value in both a fee-for-service and a VBC environment.
Contact us today to find out how Baker Tilly can help your organization.
“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