Organizational Population Health Assessments - Risk based provider insurance contracting is growing in popularity but there is a wide variation in these types of contracts and the needed capabilities to be successful under each. It is important to assess where an organization is on its population health capabilities compared to where the market in which it competes is moving. Where there are gaps, we can roll up our sleeves and help evaluate and prioritize process changes or solution implementations that are cost effective in meeting risk contract spend or quality targets.
Payer Contract Evaluation Services
Evaluating risk based payer contracts is a necessity but can be challenging given the complex nature of these contracts. Providers need the ability to measure the expected financial return, factoring in costs that they may not typically have much experience with. Of equal importance, providers need to think through operational needs to administer these contracts. A contract can show a great projected financial return but if organizations do not have the ability to administer the contract needs, it will never be successful. Our team specializes in this analytic and process evaluation exercise.
Merit Incentive Program System (MIPS) and Value Based Purchasing Program Strategies
Almost 10% of a provider's Medicare Fee For Service revenue is tied to these fee for value programs on top of the brand value of this performance being publicly reported. With the dynamic nature of these programs, what works today will not necessarily work tomorrow. There are some clear proven strategies in maximizing reimbursement from these. Efforts in these programs can also serve as an incubator for strengthening your organization's population health capabilities.
Thousands upon thousands of pages of healthcare related rule making are published by Federal and State Governments each year. It can be daunting to keep up. Many read the major industry magazine short summary articles and hope that is enough. Glenforest specializes in staying up to date on healthcare policy and can tailor impacts, opportunities, and risks to your healthcare business giving you the ability to act nimbly to new information.
Service Line Analysis/Operational improvements
Thinking about growing your ambulatory capabilities with some strategic provider or outpatient facility acquisitions? Have a poor performing service line and need to determine why? Our team has deep experience in this work across specialties and can measure revenue opportunities or identify where there are cost outliers. With a clear picture of your service line performance, better capital decisions can be made. Our team can also spear head the implementation of improvements.
Project identified but need a strong project manager to drive it to completion? Glenforest has extensive experience in project management from technology implementation to process redesign.