Context:
A national physician group with a significant present in emergency medicine was facing declining reimbursements due to a variety of market factors including the No Surprises Act. The organization recognized the need to develop a value-based offering to enhance its value proposition to health plans and requested Ridgeline support for this effort.
Approach:
Partnering with executive leadership as well as managed care and service line leaders, Ridgeline started by understanding the organization’s clinical capabilities throughout the country as well as the challenges health plans were facing related to emergency medicine service. Based on this analysis, we identified a target market and potential plans with which to launch the program. Ridgeline then collaborated with the health plan partner and developed an innovative, best-in-class value-based construct for the provision of emergency medicine services.
Results:
This engagement resulted in the launch of a value-based program with a key payer in an important market for the physician group. The program presents the opportunity for the service line to generate incremental revenues of 25-75% based on expected and potential performance levels. In the program’s first year, the organization achieved a 4-5% reduction in inpatient admissions from the emergency department. The organization is currently evaluating launching the program nationally.