1

Provider Alignment & Loyalty Programs

Providers as Business Partners

2

Business Partner Imperatives

Ensure a stable healthcare delivery platform

Finding common goals Establish accountability Communicate clearly

and often Measure performance Reward performance

3

Provider Alignment Strategies

Mutual interest for all stakeholders (provider, payer, member/customer)

Requires contract terms and conditions that are explicit

Program policies must be reasonable and transparent

Pay for performance standards with clear cut goals and outcome measures

4

Pay for Performance Methods

Clinical Measures– HEDIS/NCQA– Specialty treatment

protocols– AHRQ Community

Quality Measurement Administrative

Measures– Contract compliance– Member satisfaction– Claims submission

5

Shared Savings Programs

CMS approach (“accountable care organization”)

– Savings as determined by per capita cost of assigned membership vs budget

Commercial payer approach– Similar but adjusted for plan

design and network features Medicaid approach

– More specific to HEDIS(e.g. Pennsylvania Medicaid model

All approaches require understanding and buy-in

6

Provider Loyalty Programs

Establish brand recognition among competitors

Build long term relationships

Foster health plan membership through referrals

7

Provider Loyalty Programs Continued

Opportunities for business exchange:

– Advisory councils for ideas and feedback

– Co-marketing of programs and services to other clients

– Co-sponsor consumer health education and improvement programs

– Continuing education programs

– In-kind consulting services

8

Provider Loyalty Programs Continued

Communication Strategies- Dedicated professional

services agents- Web page portal

Program policies Provider newsletter Other health care

information links

˗ “Fax Blast” Important program

notices Education events

9

Contact Us

Eagle Run Managed Care, LLC– http://www.eaglerunmcc.com– 937-350-5457

25 years managed care experience