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Serving Health Plans

Attune Healthcare brings value to health plans through its expertise in integration.

Integrating models of care, for higher performance

Effective Care Models (click to enlarge)

 

Background

Medicare’s ACO programs demonstrate that providers in integrated models of care can reduce total costs and maintain or improve quality. In the commercial sector, large purchasers of insurance are demanding value-based payment as a path to reduce premium costs. Many health plans have developed provider networks incentivized to deliver high quality care within budgetary targets, only to find the providers are unable to deliver results in the planned timeframe.

Challenges

Product development based on narrow networks with risk-sharing contracts can consume an extraordinary amount of health plan effort, expense, and goodwill in the marketplace. When contracted providers struggle with the challenge to succeed under value-based payment arrangements, it is often unclear what, if anything, the health plan should offer to providers to kick-start success in the product. And, health plans often do not have the internal expertise to guide providers in fulfilling the promise of an integrated care model with value-based payment.

Attune Healthcare Partners’ healthcare strategists, planners, and clinicians are skilled in helping clients define a course correction for integrated processes to reduce costs and improve quality.

Services

Attune works with health plans to select key physician practices in your value-based network to lead the transition to an effective model of care, and maximum ROI. After an introduction by the health plan, we help practice leadership teams identify the factors critical to success of the integrated network. We identify the high-impact relationships for coordination, review the model of care to which they aspire, and work with them to implement modifications that produce consistent, high-quality care at a lower cost.

 

Consistent Use of Best Practices (click to enlarge)

Typically, the key to the most effective integrated care model lies in employing best practices, efficient data flows, and definition of specific work processes, rather than purchase of high cost, high tech tools. To help return savings quickly, we help health plan executives understand the most effective ways to support network providers. To help providers actively manage their clinical and financial performance, we help them define their performance reporting needs. We develop training programs, train the trainers, and assist providers in implementing training if necessary.

The Attune team is also accomplished in developing Alternative Payment Models (APMs) for facilities, specialists, behavioral health, and primary care providers, and we understand how to craft the correct balance of productivity, cost, and quality for optimal performance. As part of our service, we help clients identify internal compensation modifications to align individual practitioner compensation with the APM being used—a major loop that must be closed to produce physicians’ best financial performance.

Anticipated Outcomes

Attune delivers an efficient provider assessment process, and a concrete plan to fine-tune their care model for your integrated network product. Our integration models are constructed for successful financial results and quality improvement in the short term, and support the integrated system’s needs as its sophistication grows in managing populations and risk.

Alternative Payment Models designed by Attune have proven to be extremely successful, with annual shared savings ranging from $3,000 to over $50,000 paid per individual primary care provider, even in Medicaid. The positive financial results from the health plan’s investment in consulting expertise to key providers can be replicated throughout the rest of the network by internal health plan staff, or provider organization trainers. And, the knowledge that your health plan receives from Attune on care coordination, transitions of care, and utilization management can be the springboard to developing new, high-performing narrow networks.