Payers

Bridging traditional barriers to capitalize on new opportunities

Rising medical costs and changing competition are driving a need to control premiums and find new ways of delivering care. This demands the creation of efficient networks populated by engaged providers—a challenge all its own, as payers work to shift less-than-positive provider views about payers.

We’ve proven that physicians and payers can beneficially co-exist and develop collaborative relationships that help both groups thrive. To foster those relationships, Continuum Health’s staff work directly with payers to teach them how to more effectively engage with and educate their providers on how to succeed and improve in a range of diverse payment models.

We help our payer clients achieve their goals by:

  • Enrolling independent physicians and other provider partners into payer programs and networks
  • Accelerating the adoption of new payment models
  • Identifying clinical gaps, reducing duplication, and focusing on the highest utilizers of care to reduce the total cost of care
  • Identifying and enhancing the capabilities of low-cost, high-quality, engaged providers
  • Preserving and scaling independent physicians

 

Continuum Health bridges the historical gap between payers and providers to foster more collaborative—and more effective—partnerships. For example, we recently helped one of our payer clients excel in a shared savings program—one in which the payer and providers worked together seamlessly as one team to maximize care.

Case Study:

A Payer-Provider Collaboration Powered by Continuum’s Integrated Care Solutions

Physicians, particularly those who are independent, are critical to lowering the overall cost of care. Shifting this influence begins with greater collaboration between payers and providers. As an example, one of New Jersey’s payers collaborated with Continuum Health (on behalf of independent physicians) to create a new commercial value-based program. Providers were expected to meet seven Clinical Quality Measures and two Process and Operations Measures with a closing or completion of measures ranked on an achievement scale of 1 to 3. In addition, the shared savings model was based upon a year-over-year cost of care trend, designated as a “Per Member Per Month (PMPM) Cost”, compared to the managed population as well as a peer group trend.

Unlike other shared savings programs, the payer engaged Continuum to enroll providers into the program, as well as empower them through a range of support services, including:

  • Program administration
  • Prover engagement
  • Member attribution
  • Analytics and reporting using claims data to develop cost of care strategies
  • Practice transformation coaching
  • Care coordination for high risk and rising risk patients

At the end of the year, participating providers serving more than 6,000 members delivered an 11% reduction in PMPM and garnered significant shared savings..

As a result, the payer has expanded the program to include Managed Medicaid members. With more than 150,000 current members and a growing stable of participating providers within the state, the program is on track to produce significant big wins for providers, payers and patients.

This case study is intended to provide an example of how actual payers and providers benefitted from Continuum’s services. Continuum does not claim that the outcome of this particular case study is a typical result, or that it is necessarily representative of all those who will use its services. Continuum expressly disclaims any representations or warranties in relation to this case study or the information presented on this document.