Is your health system ready for direct contracting?

Brighton Health Plan Solutions

Is your health system ready for direct contracting?

If you’ve considered direct contracting but haven’t yet taken the plunge, now could be the ideal time.

Costs are skyrocketing for health systems. The reality of cutthroat industry competition means health systems need innovation to stay ahead of the curve. Working with insurance companies is a financial and administrative nightmare. And as an established health system, you strive to offer the highest standard of care to your patients — without breaking the bank.

But within every challenge lies an opportunity. Health system direct contracting can help, offering an efficient, all-in-one solution to many of these common challenges. Here’s how.

Why direct contracting?

Direct contracting empowers health systems to bring their own health plans to market — without involving costly insurance carriers. By eliminating the middleman altogether, direct contracting helps health systems lower their costs, increase revenue and deliver outstanding healthcare plans to patients directly.

Here are some other benefits of health system direct contracting:

  • Direct contracting enables health systems to outpace the competition. Staying ahead of the curve is crucial to increasing revenue and consistently providing patients with excellent care.
  • It facilitates new patient enrollment and increased health plan membership. Direct contracting allows health systems to offer coordinated care, as well as the ability to deliver stronger health plans to members. That means they can focus on the quality of the care they provide rather than solely on attracting and retaining patients.
  • Direct contracting involves full oversight of patient care from start to finish. With a robust direct contracting platform, treatment plans can be tracked and recorded in a single dashboard, keeping patient care streamlined and efficient. That results in higher standards of care overall.

There’s never been a better time to switch to direct contracting. But before you do, your health system needs to be prepared. In this article, we’ll outline the four key steps for preparing your health system to succeed under direct contracting.

1.   Conduct market research

Serving local employers requires a deep understanding of their needs and desires. That entails conducting thorough market research to get a pulse on what employees need — and how that stacks up against what their employers are currently offering.

Consider surveying employees on their current healthcare situation and the types of services they look for. It’s also a good idea to check out competing providers and analyze the strengths and weaknesses in their offerings. And don’t forget to look at your own capabilities; you want to make sure you can offer the scale and types of care your contracted partners need. By figuring out what’s missing in the market and using that to make your offerings stand out, you can ensure you’re meeting the needs of local employers and giving their employees top-notch care.

2.  Make sure your systems are ready

Before you make the switch to direct contracting, you’ll want to ensure you have the infrastructure to support it. Consider the following questions:

  • Can you offer a single contracting entity and network of care providers? Employers are looking for simple contract execution and coordinated care. That means your offering should go to market under one unified entity.
  • Can you offer a full-service solution? Or do you need a TPA that can bring in other specialty providers?
  • Can you quantify the quality of your patients’ experience? For example, you might provide a net promoter score to track patient experience. It can also help prove to prospective partners that their employees will receive quality care. Leverage your own success stories of managing your employees’ healthcare (if you have a domestic system) to sell your ability to manage the care of other large employers. And if you don’t already have a system in place, Brighton Health Plan Solutions will do the heavy lifting for you.
  • Can you offer regular reporting to partners on outcomes, efficiencies and other key metrics? Again, you’ll need the technology that simplifies and automates these key components of health plan management.

3.  Develop a comprehensive plan

Next, you’ll need to give employers a firm idea of what they’ll receive from your healthcare plan. This plan should outline the services you offer, such as primary care, specialty care and behavioral health services, as well as any additional benefits or incentives that will be provided to employers.

Make sure your plan is tailored to the unique needs of each employer. This may involve working with employers to understand their specific needs and preferences, and developing customized contract arrangements that reflect these needs.

Don’t forget to include a pricing structure in your plan. It should be competitive and reflect the value of the services provided.

4.  Build strong relationships with local employers and other stakeholders

Your health system is here to serve your local community. Getting to know that community is key to fostering business relationships on a basis of trust. By building relationships and forging strategic partnerships, you can establish your health system as a reliable provider of healthcare services and gain the support of local employers.

This may involve attending local business events, reaching out on professional social networking sites, and networking in person with other healthcare professionals in your area.

How a direct contracting partner can help

Switching to a direct contracting model can ultimately save your health system time and resources. And with the help of a direct contracting partner, you can rest assured that your health plan’s marketing, administrative and go-to-market strategy are taken care of, so you can focus on what matters most: your patients.

Brighton Health Plan Solutions has more than 30 years’ experience designing health plans, processing claims, managing member eligibility, providing health plan customer service and more. Interested in learning more about direct contracting? Drop us a line and we’ll be happy to answer any and all questions.

Contact Brighton Health Plan Solutions

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