GETTING FROM PRE-ACA TO POST-ACA
This Cartesian Solutions, Inc.™ Service, which is typically contracted as part of one or more of the other client Services, helps health plans set priorities and timelines for identified value-added changes in the creation and sale of commercial and public program health insurance products, in internal divisional medical and behavioral health consolidation of workflows, and in member assist and support services as they transition from volume-based to value-based payment for member products and services.
Up to this point, Cartesian Solutions, Inc.™ services have focused on assistance with: 1) creating health plan payment processes which support access to care most likely to stabilize health and reduce total claims cost in their members, 2) introducing value-added medical and behavioral health assistance and support for super utilizers, and 3) connecting service #1 and #2 by changing to insurance plan contract language that facilitates building and sustainably financing Complex Care Programs for members with the greatest health need and service use. As health plans know, services #1 through #3 are not turnkey. Changes in health care contracting and resultant services delivery do not happen overnight. Rather, prioritization and sequencing of internal health plan initiatives, often with timelines measured in years, is required for health plans to achieve their ultimate goal of supporting value-based care and associated reduction in total claims cost.
Typical Cartesian Solutions, Inc.™ consultations related to this Service for health plans include:
- Utilization of information derived from Cartesian Solutions, Inc.™ Services #1, #2, and/or #3 to create a big-picture vision of the future state;
- Recommendations on prioritization of the steps and timeline needed to incorporate value-added commercial and public program insurance plan contract language, consolidate medical and behavioral health workflows, and deploy integrated internal assist and support services so that early implementation of doable components leading to cost savings is initiated first but long-term components soon follow based on an understanding of the health plan contracting business cycle.
- Ongoing participation by Cartesian Solutions, Inc.™ experts in decision making conversations during the project deployment process.
- Creation of a dashboard for monitoring progress of the health plan contracting and member support initiative.
All consultations are customized to the needs of the client. Contact Us to discuss your needs and the potential for a consultation.