Value based program implementation

The challenge

A leading health insurance company in the Philadelphia region was looking to expand their HMO population value based program to their local and National PPO populations.  As PPO members are not required to select a primary care physician, our client needed to implement the functional and operational components required to identify the PPO members receiving care, the physicians providing the care, and the clinical and financial outcomes associated with the care received.

Our approach

Vynamic engaged 10 business functions and an external vendor to build out a primary care incentive program intended to improve both quality and affordability in the region.  In addition to overall program management, we led our client through the implementation of performance measurement methodologies, an integrated solution for data management and financial reconciliation, and a communication strategy for internal stakeholders, participating providers, and impacted members.

The results

Our client now leverages a Vynamic-defined operating model to deliver a value based program to over 300,000 attributed PPO members, enabling physician-level coordination and integration of the entire care delivery spectrum that did not exist before our engagement.  Additionally, the program is tailored to the unique needs of Philadelphia employers and their employee populations across the nation.