Optimize Network Performance with Risk-Based Contracts

Focus on the Big Picture

When examining the total profitability of risk contracting, the performance of all healthcare system operating units should be viewed holistically. For example, while an operational analysis may show that the home care unit is unprofitable, the unit's activities may drive significant reductions in readmissions and emergency room visits. This in turn reduces charges against the capitated budget and drives population-level contract surplus resulting in favorable overall contract performance. Therefore, while the system may want to improve the operational efficiency of the home care unit, it should not ignore the contribution of an individual unit or program to overall contract performance.

Make High-impact Changes

  • Identify opportunities for cost and quality improvements within populations and for specific patients
  • Profile physician efficiency and performance and implement a physician engagement plan to help reduce provider practice pattern variability
  • Reveal gaps in care and proactively intervene to improve outcomes
  • Optimize evidence-based drug substitution workflows to promote use of generics and lower-cost medications
  • Determine common points of network leakage and deploy a strategy to keep patients in network
  • Create performance reporting transparency and benchmark performance against national standards such as the Healthcare Effectiveness Data and Information Set (HEDIS®) for quality comparatives and Medical Episode Groupers (MEGs) for episodic and utilization comparatives.
  • Review population care data to ensure patients are utilizing the most appropriate care settings
  • Upgrade information technology solutions to support creation of National Committee for Quality Assurance (NCQA), Integrated Healthcare Association (IHA), and Centers for Medicare and Medicaid Services (CMS) data submission files
  • Leverage both physician and patient insights to more intelligently inform risk contracting efforts

Learn how McKesson Risk Manager can help provider networks achieve operational efficiencies and measurable cost and quality of care improvements.