Top trends for health plans
Network management
Risk mitigation and regulatory compliance
AI readiness and governance
Value-based care
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The ERP refresh – a guide to replacing the key software to power your business
Customers and program sponsors demand better quality and more cost-effective healthcare. As such, health plans must strategically adopt and scale networks while evolving the way they collaborate with internal and external stakeholders (e.g., healthcare providers, consumers and regulators). Network management strategies including comprehensive data management, proactive regulatory compliance, integration of risk management functions, early and ongoing engagement of internal audit, digital transformation and advancing value-based care programs are key to successful network optimization.
Baker Tilly’s health plan solutions can help create effective and compliant network management strategies that mitigate risk, increase operational efficiencies and outpace the competition.
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Effective strategies for health plan network management
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The adoption of value-based care (VBC) solutions is a strategic imperative for health plans today and can create transformational impacts, but often require significant changes to provider relationships, care delivery and payment models. Health plans must increase collaboration among stakeholders and establish new capabilities across people, process, and technology to achieve the goals of their VBC models such as improved health outcomes, quality of care and increased cost-efficiency.
Baker Tilly’s payment transformation framework can help your organization navigate the end-to-end complexities involved in operationalizing value-based care models, from current state feasibility assessments to creating program monitoring structures necessary to scale program successes.
Value-based care
Start achieving your digital strategy: Develop a road map to enable success
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Large multistate health plan enables performance in value-based program using shared analytics
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Digital transformation efforts lead to benefits such as improving the accuracy of a health plan’s operations, improving stakeholder trust in technology investments and creating lasting impacts to member health outcomes via reduced care gaps, identification of new opportunities for care coordination and more.
Connectivity between data, systems and insights can be transformative for an organization, but updating legacy platforms and integrating advanced technologies can be challenging. Our health plan solutions help guide your team with a structured approach to enable organizational change, streamline operations and drive greater return from achieving your digital transformation goals.
Digitization
What is value-based care data management?
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Insurance network implements SaaS platform to facilitate growth, decrease manual processes
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Health plans must navigate a complex and evolving regulatory landscape, while constantly burdened with risks that can threaten an organization’s bottom line, expose it to potential government sanctions, HIPPA violations and cybersecurity schemes. Health plans must juggle No Surprises Act (NSA) compliance, adherence to additional interoperability requirements (e.g., CMS Interoperability and Prior Authorization Final Rule), and multiple state regulations, by leveraging strategies that are accurate and defensible during audit to ensure compliance and minimize the risks of large fines and/or reputational damage.
Explore health plan solutions that can help your organization create a strategic, proactive process to reduce inherent risks while maintaining compliance.
Risk mitigation and regulatory compliance
What is organizational readiness?
ARTICLE
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Health plan achieves interoperability compliance through cloud implementation
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Network management
The health insurance industry continues to explore specific AI use cases such as reducing fraud, efficiently processing claims, improving patient care services and examining the potential for AI to predict future healthcare needs, coverage determinations as well as treatment outcomes. As workforce shortages continue to impact health plan member’s access to quality care, AI can offer health plans many benefits such as the reduction of manual processes, support in claims editing and more accurate pricing.
The task of identifying and assessing risks that could arise specifically from AI technologies intersection with the healthcare industry is not trivial. Our health plan
solutions can help your organization navigate the AI landscape from AI readiness to governance, benefits and risks included.
AI readiness and governance
What is organizational readiness?
CHECKLIST
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How AI is revolutionizing the healthcare and life sciences industry
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Digitization
How your business gets from where it is today to where it needs to be tomorrow depends on your most valuable asset - your people. We help you prepare your business to transform through a dedicated focus on the people within your organization that will lead your digital transformation.
Our team can help you design and implement comprehensive organizational readiness programs that go beyond traditional change management to align business priorities and build confidence and understanding across the organization.
Organizational Readiness
What is organizational readiness?
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The key to digital transformation is not managing change, it’s leading it
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How your business gets from where it is today to where it needs to be tomorrow depends on your most valuable asset - your people. We help you prepare your business to transform through a dedicated focus on the people within your organization that will lead your digital transformation.
Our team can help you design and implement comprehensive organizational readiness programs that go beyond traditional change management to align business priorities and build confidence and understanding across the organization.
Organizational Readiness
What is organizational readiness?
ARTICLE
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The key to digital transformation is not managing change, it’s leading it
ARTICLE
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Thoughtful program design is critical for driving the multitude of necessary initiatives to transform your business. Our programs provide for the necessary agility, collaborative execution across functions and governance required to ensure focus and align investment.
We assess your current program and project management capabilities to establish methods, control mechanisms and supporting execution and measurement capabilities necessary to effectively execute your digital transformation program.
Program Design AND Execution
Why is effective program design and execution important?
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The seven dimensions of successful program design and execution
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Organizations regularly need to revisit their strategies to transform their operations and stay on top of a progressively competitive digital landscape. Developing the right digital strategy for your organization is vital to ensure alignment with your organization’s broader goals, drive organizational efficiency and innovation and encourage adaptability to keep a competitive advantage.
Our structured, tested and multiphased approach empowers your organization to build digital competency and capabilities across the organization.
Value-based care
Start achieving your digital strategy: Develop a road map to enable success
ARTICLE
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Insurance company undergoes strategic assessment to prioritize IT strategy
CASE STUDY
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Successful digital transformation begins with a fundamental understanding of the state of your business, competition, technologies, opportunities and overall business goals — along with potential barriers to achieving them. We collaborate with your team to assess your business strategy, processes and technology across all dimensions in order to help you chart your path to success.
Our team can help you understand your current environment by identifying gaps between current organizational capabilities and future state goals, evaluating risks and determining strategic priorities.
Network management
The ERP refresh – a guide to replacing the key software to power your business
WHITEPAPER
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How an operating model assessment can help you navigate digital transformation
ARTICLE
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AI readiness and governance
Risk Mitigation and regulatory compliance
Digitization
Value-based care
Network management
Notes: /industries/healthcare-and-life-sciences/health-plans Needs tablet and mobile still https://app.clickup.com/t/86b1r6cxq