Direct Contracting/Domestic Medical Travel Implementation Team

Mission: Develop and implement a Roadmap for the employer providing a pathway to develop and implement a direct relationship with healthcare providers.

Co-leads:        Mary Seery and Elizabeth Litten(report at monthly BOA mtgs.)

Team:     8 to 12 participants.

Execution:

  • This resource will walk the employer through the basics of Direct Contracting, including health care data analysis, optimizing your self-funding strategy, and beginning the process of contracting.
  • The toolkit will provide resources for the employer, including data dashboard referrals, sample contracts, legal guidelines, lists of providers, an array of FAQ’s, obstacles to overcome and lessons learned.
  • Develop employer-provider pilots. Have three to four ACHRM employers go through this process to enable the resource to be vetted. These employers will have the option to participate in a case study and a national speaking circuit to talk about their Direct Contracting experience to assist other employers and providers.Direct Contracting Roadmap Summary
    • Purpose (include definitions).
    • Assessment: Self-Insured? Is employer positioned to make benefit design changes, any network contract restrictions?Access to their claims data?
    • Collaborate with Employer’s advisors: broker, TPA, re-insurance or other partners? Who are the internal partners that we need on involved CEO, CFO, Wellness, Legal?
    • Claims Analytics: Dashboard of pain points (understand employee needs).
    • Contract Design (reimbursement, carve outs, bundles, episode care, DRGs)
    • Negotiate Terms/Pricing (engage legal teams, define terms, include value-add)
    • Implement Contract (communicate benefit to members, value-adds for health and wellness)
    • Identify and address obstacles (push back from health plans, tracking savings, outcomes)
    • Evaluate/Renegotiate (year over year results, ROI, quality, outcomes, LTD/STD surveys.