Network Development and Operations
Your network is a critical part of your product, and your contracting strategies should reflect it
The days of straightforward “percentage of Medicare FFS” payment arrangements are behind us. Or rather, they should be.
In addition to our continuing work launching new entrants into the MA market, we are helping many experienced plans by developing smart networks: accountable care, shadow capitation, and payment bundling within their current service areas and networks. We’re developing some of the most innovative bonus and incentive arrangements in the industry by adhering to the dictum that trends may be national, but all health care is local.
GHG will assess the alignment of your products, your current network, your market, and your network requirements. We’ll help you track results – both positive and negative – back to related network components. From there, we assist in developing and executing a networking strategy, from contracting targets to model contract terms, to payment terms that match your budgets and the capabilities of your claim payment systems. Our expert teams can then provide:
• Financial modeling
• Contracting strategy
• Interim management/turn around services
• Compliance planning
• Provider contracts negotiation
• Back office contract management function.
Our services also include reviewing your current referral, authorization, medical management, and utilization management processes.
From ACO-type incentives to bundled payments and contract capitation, to full professional and global capitation – where the potential is promising, we can help design and implement these arrangements. Let’s get started. Contact us today.