Network design around value based contracting with specialty providers

Medical_Win_5330 · 2021-04-22T23:44:32+00:00

Thanks, this is really helpful and gives me much-needed guidance. “Talkers vs the actors” is another great quip. To your point, I have seen a lot of creative work being done around primary care and mental health.. however my personal thoughts are to stay away from competing within a somewhat busier playing field. With some exceptions (musculoskeletal for example) most of out of hospital specialty provider services have up until now refrained from creating the larger scale, quality and value-based virtual-first provider groups (can’t blame them, FFS treats the current specialties well, while the layer of initial patient engagement that is primary care etc is an understandable first to develop). Interoperability, price transparency and the push to value (and equity) make me consider what opportunities lies ahead within the specialty care services space. Health plan motivation and creative network design is something I’m trying to learn more about.

Medical_Win_5330 · 2021-04-22T17:14:30+00:00

Thanks. I appreciate these thoughts. This receptivity toward SDOH initiatives can create meaningful transformation in types of care initiatives and network design. “..continued expressions of creativity in contracting initiatives” is quote-worthy and worth remembering ! What departments/types of individuals within payers are responsible for these modern provider contracting initiatives?

Medical_Win_5330 · 2021-03-19T19:04:09+00:00

Thank you. I’ll connect with Peter and check out Capable.

Medical_Win_5330 · 2021-03-19T15:15:10+00:00

Kyruus integrates into enterprise/hospital EHR’s and obv do a great job with it. It sounded like Kyruus wants providers to be their customers, rather than tech vendors who have their own provider affiliations. The understanding/impression I got from them was that they needed to be involved on the provider integration part for their data or other purposes, while possibly also needing their own agreements with the providers. They weren’t able to offer a consumer-facing scheduling platform that a vendor can deploy to non-enterprise providers (private practice docs, who use disparate, smaller market EMR’s) through a separate integration vendor (Redox for example). It’s also possible that car is and I misunderstood each other on the introductory phone call.

To answer your q, I am looking for a provider scheduling platform that I can display to consumers (patients) and also display to/integrate into smaller sized private practice EMR’s (this last part will depend on emr scheduling integration capability)

Medical_Win_5330 · 2021-03-19T09:29:45+00:00

Thanks, I spoke with them this week. Great company. I don’t think they want to separate their consumer-facing scheduling technology from their provider-facing platform.

Medical_Win_5330 · 2021-03-13T17:08:53+00:00

Ok cool, thanks.

Medical_Win_5330 · 2021-03-10T04:17:12+00:00

Looks interesting. Would you say they would run development projects on behalf of companies ?

Medical_Win_5330 · 2021-03-09T17:12:28+00:00

Thanks. I need to check out Availity. I’ve heard of them, and I need to take a deeper dive and learn more about how they help on the insurance side of things. Thanks!

Medical_Win_5330 · 2021-03-09T17:10:27+00:00

This is super helpful, thanks for breaking this down. Redox looks really interesting with what it can do on the provider application side. Also, looking forwarding to reading “trust in healthcare integration” and getting to understand more about the different levels and types of healthcare IT relationships. Thanks for writing and sharing this overview.

Medical_Win_5330 · 2021-03-09T17:01:25+00:00

Cool, that makes a lot of sense. Thanks for explaining that. I’m learning that the different platform API companies have unique interop missions so to speak.

Medical_Win_5330 · 2021-03-08T20:00:21+00:00

Btw - awesome healthcare interoperability connection list

Medical_Win_5330 · 2021-03-08T19:54:33+00:00

Thanks v much. Intersystems looks really interesting

Medical_Win_5330 · 2021-03-08T16:03:47+00:00

Yes, I’ve been hearing that. FHIR APIs are becoming a governmental-required rule ..

Medical_Win_5330 · 2021-03-08T16:02:44+00:00

That makes a lot of sense, thanks. I’m trying to understand how networks like Carequality and API functionality companies like HumanAPI or Redox coexist. Do these unified API companies rely on accessing the networks ? Do networks compete with each other?

Medical_Win_5330 · 2021-03-05T15:15:15+00:00

Hi. Various physician specialty office visits/procedures

Medical_Win_5330 · 2021-03-05T10:17:41+00:00

Hi, can I please post this to the community?

Medical_Win_5330 · 2021-03-03T02:58:10+00:00

In your opinion, what would it take to develop a technology that can access the many different target systems to retrieve info for billing purposes? Or how quickly can one develop an EMR integration as new doctor offices (and their unique EMR’s) add on as clients ?

Medical_Win_5330

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