Context:
A community health system had achieved success in value-based contracting programs and was looking to expand these efforts to manage total cost of care across key payer segments. The organization’s leadership requested support in developing its payer strategy and creating payer partnerships to launch health plans and risk-arrangements in multiple market segments.
Approach:
Partnering with the organization’s executive leadership as well as managed care and strategy teams, Ridgeline analyzed the payer market landscape. This analysis was leveraged as the foundational fact set to develop its payer strategy which included the development of partnerships with the right health plans in key payer segments. Ridgeline then designed criteria to evaluate potential payer partners and executed a competitive process to select the right health plan partners in key market segments. In parallel, we developed financial models to project the impact of new payer partnerships on current financial performance across payer segments. After selecting the right payer partners, Ridgeline oversaw the development of the payer partnerships and launch of new insurance product offerings in multiple segments.
Results:
This engagement resulted in the organization selecting the optimal payer partners to execute its strategy in relevant payer market segments. Competitive insurance products were launched with payer partners which benefited from support in product design, sales and marketing, network optimization and provider engagement. Lastly, new insurance products exceeded enrollment estimates in initial years and are delivering improved financial performance for the organization.