Deploy robust provider performance management programs, informed by
analytic insights, that strengthen partnerships and enable providers to succeed in value based care
The past decade has brought an increased focus on value based care as
a way to drive affordability while improving quality, aligning provider incentives and enlisting
providers as partners.
Changes within the provider ecosystem, such as employment trends, private
equity acquisitions of care delivery, rapid acceleration of new clinical pathways to deliver care,
demand a different approach to managing provider partners.
Pressures on the provider ecosystem
are escalating and rapidly evolving as there is increasing product innovation of network chassis (e.g.,
shifting to digital, broad networks that still feel curated) and traditional providers and facilities
are facing economic pressures.
Managing this complexity requires enhanced understanding of
provider performance, enablement of provider capabilities, new and innovative partnerships, more
flexible/nimble approaches to delivery of products, and efficient management of provider relationships
and contracts.
Common issues we help our clients solve
What does variation of provider performance look like across the
network? Where is there the most variability (by provider type, by episode, by geo, by line of business,
etc.)?
How and where should we push to drive value based care models across our network and how
do we best partner and enable providers to perform in them?
What are the most likely market
impacts of taking a more active hand in provider evaluation and enablement?
How should we evolve
our provider evaluation approach, considering our specific provider programs and contracts
today?
What are effective ways to work with providers to roll out new enablement approaches
and/or build joint capabilities with providers?
How should we source our provider enablement
capabilities: build, buy, or partner to deliver?
What enablement capabilities would be needed to
support our providers as they develop new clinical care models to tackle particularly challenging
population cohorts (i.e., polychronic or complex patients)?
What provider incentive and quality
programs should we deploy and how can we make the mateiral and impactful?
1. Performance/transformation capabilities: Shared
capabilities (including payer-and provider-led functions) that enable transformation across
clinical, health management, quality, risk coding, and member engagement
activities
2. Payment/economic model: Evolve the value proposition
ranging from traditional reimbursement to deeper financial partnerships required to align provider
economics
3. Emerging care models: Capabilities to enable delivery and
monitoring of new and emerging provider care models
4. Data and integration
approach: Data, analytic, and operational integration required to support provider
relationships as well as customers and internal stakeholders
Performance/transformation capabilities
Clinical practice
change
Comprehensive, shared operating model for transforming how
care is delivered for a specific population/episode
Quality
performance
Comprehensive quality program with
structured
provider role in supporting clinical quality and other key
metrics
Risk adjustment and revenue management
Structured
approach to managing
revenue and provider documentation
activity
Population health management
Medical management
and care
management activity aligned between payer and
provider
Experience/engagement
Member service, outreach,
and
support model to meet experience and engagement expectations
Payment/Economic model
Reimbursement and risk
arrangement
Aligning payment model across LOBs to support provider
transformation and
partnership
Investment
Investment/co-investment in
practice and/or to build new capabilities or services (e.g., on-site transfusion,
ambulatory surgical facilities)
Joint Venture
Joint
venture to open new service lines or sites of care
Practice
ownership
Full ownership of practice or group
Emerging care models
Contract and reimbursement
management
Financial/analytical capabilities to
define, measure,
and administer provider risk arrangements
(incl. hierarchies, cross-program
coordination)
Pop health analytics
and
integration
Sharing bi-directional
data,
metrics, and insights to enable clinical activity changes to
improve
performance
Provider financial
reporting
Capabilities to provide regular
financial reporting on
risk arrangement performance
Customer and internal
reporting
Capabilities to measure and report
customer and
internal segment level impact of provider risk arrangements
Data and Integration Approach
Data: Necessary data and associated transparency required
to support foundational capabilities
Integration approach: Method for
aggregating data and insights from various foundational systems to support all capabilities
(including development of interface layers / aggregation approaches where needed)
Provider performance measurement insights drive optimized network performance
outcomes
Source: Oliver Wyman analysis
Goals for provider performance measurement
Risks to avoid
Oliver Wyman partners closely with our clients to design and
develop provider enablement capabilities and solutions based on evaluation and deep
understanding of provider performance and maturity.
Developed a care management solution to
support physicians deploying patient care models for practices ranging in size
from 70 physicians to 300+ providers. Read
more
Developed the near-term approach to deliver
provider enablement “must haves”, while laying the foundation for
longer-term enablement capabilities to improve network performance. Read
more
Defined a comprehensive framework for the
full set of provider enablement capabilities needed to enable value-based contract
success. Read
more
Facilitated an understanding of the current
state of the provider quality space and developed an organizing framework
for provider quality improvement initiatives. Read
more
Contact Us
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Impact practice? Get
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