Opportunity Identification

Developing value-based care programs that work requires an alignment between patient access, provider utilization, payer economics, and quality. This alignment—enabled by our proven ability to serve as a trusted liaison between providers, employers, and payers—is essential to the long-term success of any value-based care program.

Opportunity Identification

Outcome
When Opportunity Identification is complete, GHA delivers to the client a defined program of prospective bundled portfolio care opportunities:

  • A market assessment report defining which payers, patients, and employers are likely to be the target market for the program.
  • A portfolio of packaged or bundled care services for the program defined by a continuum of care, care episodes, provider participants, and care venues.
  • Financial parameters for the program, ready to be aligned to clinical goals—helping to ensure the financial success and sustainability of the program.

Market Assessment

Identifying opportunity begins with gaining an in-depth understanding of the target market—demographics and geography—as well as detailed insight into the opportunities available in the market: demand for services, payer coverage for these services, and variations in costs and payments.

Patient demographics and market demand
The age distribution, health statistics, and healthcare usage rates for patients in a particular market area are an essential factor in assessing market opportunity. What is the current demand for specific medical services? Is it forecast to expand? What is the payer environment? Are there major payers and/or self-insured large employers in the market area?

Evidence & Proof

In the next phase of Opportunity Identification, GHA studies years of patient case data from the client, transforms it into proprietary GHA value-based packages, and then compares financial data (including rates) to usage data for the market as a whole. The delta between these two is a sign of possible opportunity. GHA uses proprietary algorithms to model and test programs that assess risk and align patient access and patient utilization with employer/payer economics.

In every case, these programs prioritize quality of care, making it the primary factor driving reimbursement, incentives, and risk sharing.

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