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Provider Collaboration

Sharing risk and reward puts a premium on effective partnership.

As plans follow the changing paradigm from volume to value, avenues for collaboration are emerging. These new relationships can help determine how to pay and reimburse providers. They will play a role in addressing medical costs. And they can be foundations on which to build lasting patient engagement. But collaboration itself is a strategic challenge. What will your approach look like? Who will your partners be? And what capabilities and financing will you need?

In planning and implementing a plan-provider collaboration strategy, health plans will need to focus on critical issues like reimbursement, transparency, consolidation and clinical risk-sharing. Our industry-seasoned practitioners keep your long-term goals in mind when they work with you on the following market offerings:

  • Provider collaboration strategy. Diagnose your market and the providers you consider working with, creating an economic value analysis that guides the creation of a high-performing network model.
  • Clinical strategy. Determine the new model that will direct care along lines that improve outcomes and distribute risk appropriately and consider what infrastructure you have to build to delegate within that model.
  • Provider information management and reporting. It takes effective tools to make reporting and information exchange work the way they must and analytics is essential in making sure of the outcomes. As you change your relationships with providers, your organization may need to consider the implications for people, processes and technology.
  • Payment innovation. Collaborating with providers, sharing risk and responsibility and apportioning revenue within a value-accountable system will likely take new networks.

As you chart your course in the value-based environment, it will be important to build with the end in mind, while focusing on the current reality. First, the entire industry isn’t adopting the new model in lockstep—markets are evolving at different speeds and you will likely need to build a continuum of solutions to serve providers at different points on the spectrum from volume to value. It’s important to judge a collaborative partner by more than its stated willingness to share risk. Due diligence can tell you where a provider wants to take its population and how its human capital and leadership align with yours. Potential partners will likely vary in their appetites for change, in their willingness to make the necessary investments and in the barriers they face.

A broad approach to collaboration in value-based care can help you identify and implement your strategy more quickly, with less waste. Sharing risks, costs and revenue carefully is an important component of determining medical loss ratios. And intelligent value-based billing approaches can put more of what you and your partners earn on the bottom line.

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Sonal Kathuria, Director, Deloitte Consulting LLP

 

As used in this document, "Deloitte" means Deloitte LLP and its subsidiaries. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

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