Managed Care / Risk Readiness Gap Assessment

Assessing your readiness for risk.

There is an increased interest on the part of payors to find providers who can enter into risk-based contracts in exchange for access to the premium dollar. Market pressures include:

• Managed care penetration
• Financial incentives for providers and members
• Ongoing implementation of care transformation programs such as the Medicare Access and CHIP Reauthorization Act (MACRA)

Provider organizations should only consider entering into such arrangements following a thorough understanding of risk-readiness gaps. To help our clients ensure the right trajectory for success, we have developed a systematic approach to objectively assess current capabilities, strengths and opportunity areas.

 

Our Approach

Specifically, we assess readiness for population health management and help organizations determine the appropriate level of risk arrangements they may be able to take on. We guide clients through the process of understanding and evaluating their populations, current managed care arrangements and system capabilities to determine the best-fit opportunities to achieve greater financial integration with payors/providers while right-sizing their population health infrastructure. Our work includes:

• Health plan and capitated population valuation, due diligence and risk assessments
  • Assessment of the partner/provider network, including:
    • Gap analysis of partner capabilities and service offerings along with recommendations for gap closure for key strategic partners in achieving outcomes and preparing for risk-bearing arrangements
    • Opportunities to improve performance against existing contract
• Analyzing the efficacy of the current managed care contracting strategy and offering opportunities for enhancements