Payers
Bridging traditional barriers to capitalize on new opportunities
With the rise of medical costs and changes in competition, professionals are forced to control premiums and find new ways to deliver care. This demands efficient networks populated by engaged providers—a challenge all its own, as payers work to shift their less-than-positive reputation among providers.
At our healthcare management group, 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. We teach them how to effectively engage with their providers and educate them 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, our healthcare management group 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
Independent physicians are critical to lowering the overall cost of care, and shifting this influence begins with greater collaboration between payers and providers. As an example, a major payer collaborated with Continuum Health 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 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. This was designated as a “Per Member Per Month (PMPM) Cost” and compared to the managed population as well as a peer group trend.
Unlike other shared savings programs, the payer engaged our healthcare management group to recruit and organize independent providers and enable 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 Year 1, 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. In Year 2, more than 150,000 current members and a growing stable of participating providers within the state are on track to produce significant wins.
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.