Today’s health care market is shifting to a value-based, outcomes-focused environment where providers and insurers must work closer together, often with non-traditional providers, to ensure effective, efficient care delivery. Does your network provide access to the right care and the right resources? Do you know which organizations you should partner with to reduce out-of-network utilization? Is the established clinical governance effective?
At COPE Health Solutions, our multidisciplinary team of industry and clinical experts help clients assess and optimize their provider networks to improve financial and clinical performance and meet the needs of all members today.
Services in Network Development Solutions include:
Created a statewide all lines of business network in a large Northeast state enabling growth in Medicaid and the launch of new Medicare Advantage products to grow market share
Implemented claims analytics systems and best practices into provider owned health plans and self-insured employers enabling targeted insights and financial modeling to identify and quantify specific total cost of care and quality initiatives
Supported a health plan in preparation for a dual eligible procurement through the development and implementation of a new care model and network optimization