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.
- 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.