Find and implement a specialty physician network carve out: Benefit Managers
Scenario
XYZ Corp, a mid-sized manufacturing company, discovers high musculoskeletal (MSK) treatment costs. HR Director Hugh explores a specialty network carve-out for MSK care, facing challenges in projecting savings, comparing networks, designing the program, communicating changes, and managing implementation.
Job Difficulty and Outcomes
Average Difficulty: 3.96
Total Outcomes: 45
Job Steps
- Analyze current population health needs (3.7)
- Research solutions including specialty network options (3.8)
- Design carve out program structure (3.8)
- Sell program internally and secure agreements with chosen provider (4.2)
- Plan implementation strategy (3.8)
- Launch and implement the new program (4.0)
- Roll out specialty network carve out (4.2)
- Review and refine program performance (4.2)
Themes
Stakeholder Communication and Change Management (4.3)
This theme focuses on the difficulties in effectively communicating the new program to various stakeholders and managing the transition process.
- (4) Increase the effectiveness of the employee communication strategy
- (5) Increase the clarity of communication about program benefits
- (4) Increase the effectiveness of instructions for accessing the network
- (4) Increase the engagement of key stakeholders in the process
- (5) Decrease the resistance to change among employees
- (5) Decrease the disruption to ongoing patient treatments
Performance Monitoring and Optimization (4.3)
This theme covers the challenges in implementing, tracking, and refining the carve-out program to ensure its effectiveness and success.
- (5) Increase the accuracy of utilization tracking
- (4) Increase the speed of addressing implementation issues
- (4) Increase the efficiency of handling out-of-network care requests
- (5) Increase the accuracy of comparing outcomes to initial objectives
- (4) Increase the quality of data-driven decisions for adjustments
- (5) Increase the accuracy of financial impact assessments
- (4) Increase the effectiveness of program optimization efforts
Data Analysis and Program Design (4.1)
This theme encompasses the challenges in analyzing health data, designing the carve-out program, and aligning it with existing structures and stakeholder needs.
- (4) Increase the accuracy of identifying high-cost specialty areas
- (5) Increase the clarity of defined goals for the carve out
- (4) Increase the quality of data used for cost analysis
- (4) Increase the accuracy of projecting potential cost savings
- (5) Increase the clarity of services included in the carve out
- (4) Increase the effectiveness of reimbursement models and rates
- (4) Increase the appeal of member incentives for using the network
- (3) Decrease the complexity of the program structure
All Outcomes by Difficulty
| Difficulty | Outcome |
|---|---|
| 5 | Increase the accuracy of projecting potential cost savings |
| 5 | Increase the ease of comparing provider integration capabilities |
| 5 | Increase the clarity of services included in the carve out |
| 5 | Increase the clarity of policies for out-of-network care |
| 5 | Decrease the time it takes to negotiate contract terms |
| 5 | Increase the alignment with existing health plan contracts |
| 5 | Increase the seamlessness of system integration planning |
| 5 | Increase the clarity of communication about program benefits |
| 5 | Decrease the resistance to change among employees |
| 5 | Increase the accuracy of utilization tracking |
| 5 | Decrease the disruption to ongoing patient treatments |
| 5 | Increase the accuracy of comparing outcomes to initial objectives |
| 5 | Increase the accuracy of financial impact assessments |
| 4 | Increase the accuracy of identifying high-cost specialty areas |
| 4 | Increase the quality of data used for cost analysis |
| 4 | Increase the clarity of defined goals for the carve out |
| 4 | Decrease the time it takes to review provider proposals |
| 4 | Increase the quality of provider evaluations based on key metrics |
| 4 | Increase the accuracy of assessing provider network breadth |
| 4 | Increase the alignment with existing health plan structures |
| 4 | Increase the favorability of negotiated terms for the employer |
| 4 | Decrease the number of potential conflicts in coverage |
| 4 | Increase the comprehensiveness of quality metrics in agreements |
| 4 | Increase the efficiency of role and responsibility assignments |
| 4 | Increase the effectiveness of the employee communication strategy |
| 4 | Increase the comprehensiveness of the data exchange plan |
| 4 | Increase the effectiveness of instructions for accessing the network |
| 4 | Increase the engagement of key stakeholders in the process |
| 4 | Decrease the time it takes to implement the program |
| 4 | Increase the speed of addressing implementation issues |
| 4 | Increase the efficiency of handling out-of-network care requests |
| 4 | Increase the frequency of performance reviews |
| 4 | Increase the quality of data-driven decisions for adjustments |
| 4 | Increase the effectiveness of program optimization efforts |
| 3 | Decrease the time it takes to analyze healthcare utilization patterns |
| 3 | Increase the number of potential solutions identified |
| 3 | Decrease the time it takes to shortlist suitable providers |
| 3 | Decrease the complexity of the program structure |
| 3 | Increase the effectiveness of reimbursement models and rates |
| 3 | Increase the appeal of member incentives for using the network |
| 3 | Increase the clarity of performance guarantees in contracts |
| 3 | Increase the clarity of the implementation timeline |
| 3 | Decrease the time it takes to develop the implementation plan |
| 3 | Decrease the time it takes to train HR teams |
| 3 | Increase the frequency of updates to stakeholders |
| 3 | Increase the frequency of member satisfaction surveys |
| 3 | Decrease the time it takes to identify areas for improvement |
| 2 | Decrease the time it takes to determine specialties for inclusion |
