Context:
A large clinically integrated network needed a refresh of its payer strategy and value-based strategy. The organization recognized that it could leverage its payer strategy to grow market share and that this would likely require closer partnerships with health plans.
Approach:
Ridgeline assessed the market and payer landscape to understand competitive dynamics. In collaboration with the organization’s executive leadership, we developed a new payer and value-based strategy for the organization. Close partnerships with health plans in Medicare Advantage and Commercial segments were important elements of this new strategy. Ridgeline then developed and executed a competitive process to choose the right payer partners in the Medicare Advantage and Commercial market segments. For each partnership, we developed the partnership structures, key financial terms as well as the division of functional and financial responsibilities.
Results:
The payer strategy and value-based strategy developed during this engagement is currently being executed. The payer partnerships exceeded membership targets in first two years. Further, these partnerships have played a role in helping the organization to stabilize and begin to enhance market share.