Healthcare: network development on behalf of a provider sponsored managed care organization
Challenge:
The organization needed to transform its delivery model from a provider of health care services to a provider sponsored health plan and was approved to participate in the Fully Integrated Dual Advantage (FIDA) demonstration program. However, they did not have a comprehensive provider network to support their application. As a new and relatively unknown entity, they turned to us for our market expertise and provider relationships. We worked with the client’s leadership team to develop a network contracting strategy.
Solution:
Mazars assembled an experienced project team to deliver a viable network to meet the approval of CMS and the New York State Department of Health by implementing the following:
- Developed provider recruitment collaterals
- Identified preferred provider targets by specialty type to achieve network adequacy standards
- Established rate and language parameters to adhere to financial projections
- Negotiated agreements with health systems, hospitals, large physician groups (including IPAs and Faculty Practices), ancillary providers and individual physicians
- Implemented a vendor identification and selection process to contract for behavioral health services
- Electronically organized and tracked all executed agreements and credentialing documents
- Monitored network adequacy throughout the engagement utilizing Quest Analytics and proprietary tracking reports to ensure regulatory compliance
- Produced required submission reports in compliance with federal and state regulatory standards
- Utilized data management and reporting tools to collect, organize and transmit information back to the client
Results:
We delivered a completed FIDA network within the client’s required deadline leading to:
- Achievement of regulatory compliance in nine (9) counties of downstate New York
- Maintained network reimbursement rates within client established parameters
- Established relationships with key health systems in all targeted counties
The information provided here is for general guidance only, and does not constitute the provision of tax advice, accounting services, investment advice, legal advice, or professional consulting of any kind. The information provided herein should not be used as a substitute for consultation with professional tax, accounting, legal or other competent advisers.