Seven community-based providers formed a Regional Care Collaborative (RCC) to offer care management and medical homes to an enrolled population based on the Triple Aim Goals. Their primary client, the state Medicaid Agency, was considering additional risk arrangements—shared savings; P4P; bundled payments; or a partial capitation. With over 40,000 members, the RCC needed to assess their capabilities, including those of their administrative partner, to manage risk. They reached out to Newpoint Health Advisors to conduct the analysis because of our extensive experience in these areas.
The Newpoint team of clinical, HIT, and management experts conducted an operational and financial assessment with Milliman, an actuarial consulting firm. Together, we developed a future state roadmap, and provided strategic direction throughout an RFP process. Newpoint conducted a comprehensive gap analysis that identified strengths and challenges throughout the organization to support a transition into a population health and risk-based business model.
We presented recommendations to senior management to support planning for next steps that included the following:
- Execution requirements
- Fiscal risk appetite
- Infrastructure requirements
- Long-term commitment to change and platform for urgency
- Link between Strategy-Operations-People
Newpoint acted as liaison to Milliman, working together to develop a projection of actuarial soundness.
Our analysis identified strengths in primary care, care management, financial management, informatics, and in maintaining a successful working relationship with the state agency, crucial for future growth. We provided a roadmap for change that began with repurposing—redefining the organizations’ Mission and Vision and creating consensus among senior leadership—to build the foundation for future change.
The organization has been moving towards building capacity for population health, but is still determining its collective appetite for risk. A number of infrastructure initiatives have begun to further expand their care management and informatics capabilities. This process will accelerate as they begin to address State requests for competitive bids for future contracts.