SERVICES

Guiding payers to optimal relationships with providers

Payers must navigate an ever-changing competitive landscape and regulatory environment, partnering with providers to meet and exceed their members’ expectations.

Successfully Navigating Your Provider Relationships

01

Members expect more from health plans

With increased price and quality transparency, consumers can make more informed decisions, and are expecting more from health plans.

02

Rising costs make efficient, high quality care delivery essential

Rising healthcare costs make it imperative for payers, seeking to stay on the leading edge, to pursue new strategies to provide efficient, high-quality care.

03

Developing the right provider network and provider partnerships are now critical to success

To remain competitive, payers need to pursue network optimization efforts and develop new value-based partnerships with primary care providers and key network participants.

Ridgeline Health Group will set you on the path to optimal provider relationships.

The relationship between payers and providers is one of the most critical nexuses of the healthcare industry. Ridgeline Health Group specializes in guiding our clients through challenging organizational and competitive landscapes to cultivate more effective relationships among payers, providers and members. Our team offers a comprehensive set of services to optimize your provider relationships and insurance products.

Within the payer arena, Ridgeline has extensive experience guiding provider-sponsored health plans because of our unique understanding of both provider and payer organizational dynamics.

Our Services

FOR HEALTHCARE PAYERS

Let us help you achieve your goals by developing and executing on new approaches to relationships with providers and optimizing your insurance products.

Provider Network Development & Management

Provider networks are key to staying competitive given the critical role they play in effectively managing costs, ensuring timely access and delivering high-quality care. Ridgeline can support you with both network development and network optimization efforts.

Our team can augment your existing resources to develop your network as your organization expands. We are also well equipped to support data-driven network optimization efforts to create the right curation of providers to meet your organization’s needs.

Innovative Provider Partnership Development

Health plans face considerable pressure to grow membership, manage premium increases and effectively control costs. Many health plans have found innovative partnerships with providers as an effective solution.

Our team can help you choose the right provider partner and structure the partnership appropriately to achieve your desired outcomes including membership growth, a differentiated member experience, and / or cost efficiency.

Value-Based Program Strategy

Payers are continually challenged to keep premium increases low amidst rising medical expenses. Many health plans are pursuing a broad value-based strategy to align incentives with providers, controlling cost and improving quality.

Our experts have deep experience designing, developing and implementing the right value-based program to achieve long term success across lines of business.

Insurance Product Development

Designing competitive insurance products in an ever changing landscape is always a challenge. Leveraging our data-driven approach and deep industry expertise, our team can support your insurance product development efforts.

We partner with our clients to complete market analysis, develop product recommendations and collaborate cross-functionally to price, market and sell new products.

Historical approaches to managing relationships with providers no longer produce the same results. Whether you are looking to expand or optimize your provider network, develop innovative partnerships with providers or design new insurance products, Ridgeline Health Group is here to support you.

We understand the pressures that payers are facing today and we are happy to help.

Meet with the Ridgeline Team

Value-Based Program Development & Execution for Multi-State Health Plan

A multi-state health plan focused on serving the Medicare Advantage and Dual-Eligible segments wanted to optimize its performance. In particular, the organization was interested in developing stronger engagement of primary care physicians to achieve appropriate risk adjustment performance and better management of total cost of care. Read how Ridgeline helped them.

View Story

Our People Are...

Experienced

Collaborative

Innovative

Passionate

Our team combines deep payer and provider industry experience with an analytically rigorous approach to work. We understand the intricacies of relationships between payers and providers. We are here to listen and help you find the best path forward.

Meet the Team

Payer Insights

INSIGHTS

Payer-provider partnership success stories

As the great convergence of providers and payers continues, many health systems are evaluating their best path forward.

Lead your organization with confidence, no matter what comes your way.