Risk-Ready Providers are Key to Successful Networks in ACA Programs

Share Article

RowdMap, Inc. talks about Using Government Benchmarks to Configure Your Network Around Risk-Ready Providers at California Association of Health Plan's Seminar

Co-Founder and Chief Scientific Officer of RowdMap, Inc.

Josh Rosenthal, PhD, Chief Scientific Officer and Co-Founder at RowdMap, Inc., will be speaking on the applicability of government data to network design at the California Association of Health Plans (CAHP) Seminar on Provider Networks this week in San Francisco, CA.

Newly released government data on physicians, hospitals, and other provider classes has created a sensation on the evening news, but the real opportunity comes when health plans use these government benchmarks to inform network strategy. Understanding these data to understand which providers in your network are ready to take on risk will be key as CMS moves away from fee-for-service payments.

For the first time ever, these new data releases allow every health plan or risk-taking provider in the nation to understand unwarranted variation in the practice of medicine among the providers within their geographic footprint. Furthermore, these data releases have allowed the creation of a nationwide baseline for appropriate utilization of unwarranted conditions. RowdMap's Risk-Readiness Benchmarks help to identify high quality, high efficiency delivery of care as health plans and providers develop more advanced and innovate risk-sharing arrangements.

The newly released government data has proven exceptionally powerful in building relationships with providers to improve member experience and delivery of care. By identifying areas of unwarranted variation, a health plan can identify potential areas of risk and exposure in value-based arrangements. Using a provider-centric approach using government benchmarks has been shown to outperform standard risk stratification techniques.

Health plans can use these benchmarks in discussion with providers as well as inputs to more advance risk-sharing and pay-for-performance contracting arrangements. Health plans should become well-versed in using these data sets in provider conversations, since the increasing volumes of government data released will become an essential input into running any health plan over the next few years.

Understanding these data will be essential to participate in a pay-for-value world —especially in California where risk and performance arrangements are the norm, and network adequacy needs to be aligned with network quality. The new benchmarks are essential to understanding where natural high and low value referral pathways exist, and how aggregate practice patterns and geographic population characteristics influence the overall performance of a network. These insights make network configuration a key strategic differentiator and determine an organization's ability to succeed in risk arrangements.

About RowdMap, Inc:

RowdMap helps health plans, government payers, providers, and hospital systems develop Risk-Readiness strategies to excel as they transition from fee-for-service to pay-for value. As CMS sunsets fee-for-service payments, RowdMap's Risk-Readiness Platform helps payers and providers identify and manage unwarranted and unexpected variation. RowdMap identifies ideal provider arrangements based provider practice patterns and population characteristics within a geography. Payers and providers then use RowdMap to build strategies around these new risk relationships. RowdMap helps them enter new markets, segment populations, identify waste, design products, and understand referral patterns. RowdMap's platform comes preloaded with government benchmarks out of the box—no IT integration required. RowdMap's Risk-Readiness Platform works across all market segments and has significantly larger returns than traditional medical economics approaches.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Joshua Rosenthal
Visit website