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Third Party Administration

Value-based care business process management services for hospitals, health systems, physicians, and payers that want to optimize revenue from alternative payment models by improving clinical outcomes and reducing operating costs.

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EnableSuccess In Value-Based Care

  • Transition successfully to value-based care. Our strategy, infrastructure, and technology expertise can help you establish a strong foundation for controlling patient care costs, improving outcomes, and boosting margin growth.
  • Create a viable and sustainable care delivery model. Leverage coaching and quality improvement services, PCMH and ACO model development and application offerings, and other process management services to help you thrive in a value-based reimbursement environment.
  • Develop your provider network. Our process management services help you identify, evaluate, and integrate primary care physicians, specialty physicians, and facilities to participate in a streamlined care delivery model.
  • Leverage care coordination to improve population health management. Our care coordination services help you improve patient outcomes by tracking and communicating patient care, protocols, and progress across the care continuum.

Leverage Our Value-Based Care Process Management Expertise

  • Strategic management and analytics

    • Build the administrative and operational infrastructure you need to successfully transition to a value-based reimbursement model. Our expertise can help you control patient care costs, improve outcomes, and boost margin growth.
    • Conduct a transformation assessment to identify how you can enhance profits and improve outcomes through your current payment arrangements. You can also evaluate the impact of shared savings and/or shared risk models.
    • Develop your accountable care strategy and operational approach. Leverage our experience as you negotiate payer and provider contracts, develop innovative payment models, and manage the complexities of value-based medical claims management.

  • Network development and physician recruitment

    • Identify, develop, and integrate a network of primary care and specialty physicians and high-quality, low-cost facilities to participate in a streamlined care delivery model.
    • Evaluate physicians for inclusion in your network by analyzing their clinical quality, service quality, and utilization management data.
    • Support the recruitment, credentialing, and the successful onboarding of your provider network.

  • Practice transformation and care coordination

    • Offer onsite practice assessments, coaching, and quality improvement initiatives to support each provider network member’s transition to a value-based reimbursement model.
    • Develop and apply the right value-based care model for your organization such as PCMHs, ACOs, and other relevant models.
    • Leverage care coordination resources for high-need patients. Track and communicate patient care, protocols, and progress across the care continuum.

Our outcomes

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White Paper

Risk Adjustment Methodology of Prometheus Analytics

White Paper

Risk Adjustment Methodology of Prometheus Analytics

Explore how providing different risk adjustment models for each episode of care captures the episode-specific contribution of risk factors to resource use.

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Case Study

Insights, Metrics, and Clinical Support Help Primary Care Providers Achieve VBC Success

Case Study

Insights, Metrics, and Clinical Support Help Primary Care Providers Achieve VBC Success

Learn how a health plan improved the overall quality of care while helping independent PCPs and practices meet requirements of an alternative payment program.

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Article

The Interoperability Imperative

Article

The Interoperability Imperative

Learn more about how interoperability unlocks silos in enterprise applications and connects the business logic needed to support value-based reimbursement.

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