A program opportunity is in hand when market information and case data clearly define a target context (comprising payers, patients, and specific employers), a portfolio of services, a target market, and sustainable financial parameters.
Transforming that business and financial case into a true value-based healthcare program—moving from concept to operational readiness—draws on several GHA competencies.
The GHA design process includes the construction of the financial and risk models used to set provider payment and clinical goal incentive schedules. It also includes building provider networks and credentialing those providers within the program.
Business and legal consultation
GHA can work with provider networks to consult on corporate structure, board and governance models, the development of participation agreements for providers, and the creation of contracts between payers, employers, and providers.
Marketing and promotion
As a program is launching, GHA works with clients to develop the presentations and other materials they need to convey the program’s value proposition to payers and employers—helping to translate the value-based program’s commitment to clinical quality for an audience accustomed to a language of cost and delivery.
Clinical quality initiatives
Continuing clinical success requires ongoing collection and assessment of outcomes data. GHA works closely with clients to develop clinical governance and goal models that gather necessary clinical goals and outcomes data to align to the financial goals of the value-based program. GHA then works to ensure that the data is clear, concise, trackable, and actionable.
Our ability to seamlessly connect providers and payers within value-based care programs is based on our proprietary software platform, Axia™. An open API allows us to seamlessly integrate different financial and operational systems with minimal impact to current revenue cycle processes—including those of different providers and payers. This integration—including full data security and HIPAA controls—is an essential element of our value-based care solutions.
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