PYA’s diverse team of experts (operations, data analytics, managed care contracting, coding, strategy, regulatory, and revenue cycle) has the experience to meet your organization’s risk-based contracting needs. Our four-phase data-driven approach is tailored to your specific market.
Phase 1: Assessment
Conduct a thorough gap analysis and prepare a specific action plan
- Has the leadership team assessed its readiness for risk-based contracting?
- Do all entity stakeholders fully understand riskbased contracting?
- Has the operational infrastructure been established?
- Has the provider entity invested in data management to monitor key metrics?
Phase 2: Market Analysis
Conduct an external market analysis
- Determine the provider entity service area.
- Determine the payer market share by payer class.
- Determine provider entity patients by payer class.
Phase 3: Contract Negotiations
Prepare for and engage in contract negotiations
- Determine level of risk the provider entity is willing and able to assume.
- Determine attributed membership for the patient population identified.
- Determine criteria for key business terms.
- Request proposals from selected payers.
- Negotiate key business terms.
Phase 4: Implementation
Establish a monitoring process and commence performance
- Establish critical reports to manage the population.
- Establish care management workflows.
- Establish regular data feeds from payer.
- Regularly educate providers on progress.