Evaluating Current Network Performance
- Plans can evaluate performance of their existing Hospital and Physician/Ancillary rates to determine market level performance
- Use the tool to help track ongoing contract maintenance (eg. multi-year contract terms, contract inflationary adjustments, and hospital chargemaster offsets)
- Establish annual contractual budgets and track performance
- Utilize as a tracking mechanism for contract remediation projects
- Analyze network performance on either a regional (multi-county) or local (single county) basis
- Model the effects of Government payment changes over a multi-year period to help determine future product and network requirements
|
|
Evaluating Potential Network Expansions
- For Commercial business uses product cost estimates, membership projections and medical expense assumptions to establish a budget for the expansion region.
- For Government business uses state rates, federal ratebook rates, member risk adjustment estimates, membership projections, and medical expense assumptions to establish a budget for the defined service area.
- Hospital System marketshare, Cost to Charge ratios, and CMI efficiency, are used to help develop contracting targets along with Plan input on product marketability.
- Initial targets are established and as markets are rolled out contract performance is able to be tracked as agreements are executed
|