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Portico Provider Contract Maturity Model

On-going innovations in provider reimbursement models are creating a greater burden on administrative processes for health plans and providers. Aside from creating an administrative burden for health plans, it is also one of the greatest points of dissatisfaction for the provider. The need for greater agility and accuracy is driving health plans to re-think their provider contracting processes and supporting systems.

There is no question that there is value in applying technology to help improve provider contracting. However, questions do arise on how to start and mature a provider contracting system initiative.

1. Organize and Centralize:

The first step in maturing a health plan’s provider contract initiative is to organize and centralize all of their provider contracts. To achieve this objective, health plans need a solution that enables the ability to identify, centralize and digitalize all of their provider contracts.

• The result of this step is that health plans achieve easy electronic access to their provider contracts, lower the administrative complexity of creating and maintaining contracts, and gain increased capabilities for contract audit support.
  

2. Standardize and Automate:

The second step in maturing a health plan’s provider contract initiative is to standardize and automate their provider contracting processes. To achieve this objective, health plans need a solution that enables the ability to standardize the contract creation process, deploy automated contract workflows and enable compliance to reimbursement standards.

• The result of this step is that health plans achieve increased adherence to contract standards, increased, end-to-end visibility of the provider contracting process, and an increased ability to reduce medical costs.
  

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3. Integrate and Empower:

The third step in maturing a health plan’s provider contract initiative is to integrate and empower the standalone contracting solution. To achieve this objective, health plans need a solution that enables integration to other downstream systems, provides a common network repository and end-to-end, rules driven workflows across departments.

• The result of this step is that health plans achieve increased capabilities for new reimbursement methodologies, greater ability for contract-to-claim translation, and improved transparency.
  

4. Analyze and Advance:

The fourth step in maturing a health plan’s provider contract initiative is to enable analytics to the integrated contracting solution. ITo achieve this objective, health plans need a solution that enables contract intent review, budget modeling, and provider incentive modeling.

• The result of this step is that health plans achieve increased capabilities for proactive performance management, greater ability for incentive alignment, and improved provider buy-in of the health plan contracting process.
  

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