ALIGNMENTS THROUGH ASSESSMENTS
Building payer and provider partnerships require a thorough understanding of mutual goals, tolerances, capabilities, and limitations. That is why P4P believes that it is neither pragmatic nor fiscally responsible for providing consulting advice before conducting an in-depth client assessment. To provide meaningful alignment feedback, P4P delivers a suite of comprehensive assessment services as listed below.
Assessment Process Overview
Operational and Financial Review
P4P works with each client to identify goals, objectives, metrics, and individuals that may contribute to the scope of the engagement. After that, the assessment process examines process workflows, policies, procedures, reporting, and training against survey responses. P4P then measures responses against requested documentation to determine alignment, risks, and gaps. Finally, P4P evaluates financial performance by analyzing claims data against key performance indicators (KPI) and payment variances. The final product produces a Summary of Findings, Conclusions, Identified Opportunities, and Recommendations to its clients.
Operational and Financial Review
P4P works with each client to identify goals, objectives, metrics, and individuals that may contribute to the scope of the engagement. After that, the assessment process examines process workflows, policies, procedures, reporting, and training against survey responses. P4P then measures responses against requested documentation to determine alignment, risks, and gaps. Finally, P4P evaluates financial performance by analyzing claims data against key performance indicators (KPI) and payment variances. The final product produces a Summary of Findings, Conclusions, Identified Opportunities, and Recommendations to its clients.
Comprehensive Payer Contract Review
A critical step in P4P’s alignment process is Payer Contract reviews. Therefore, P4P’s contract review includes language, rate schedule, and payment evaluation to identify both alliances and divisions. P4P examines payer contracts for their clarity, consistency, and administrability of critical provisions, processes, and methodologies. We evaluate payer agreements to ensure that they foster fair and sustainable terms for all concerned, especially in light of bundled, value-based / risk, and capitation contracts.
Claims Analysis and BI Dashboards
Healthcare data is often fragmented, which limits organizations’ capacity from reaching meaningful insights. For this reason, P4P’s claims analysis uses Business Intelligence to interpret and present data using interactive visual dashboards. P4P’s sophisticated BI and AI tools associate disjointed provider, member/patient, claims, product, and service data. Our data integration allows our clients to thoroughly examine their business concerns by asking probing questions of Who, What, Where, When, and Why. Our 24-7 access through any web-enabled device, allows our clients to have the freedom to manage their business, on their terms.
Claims Analysis and BI Dashboards
Healthcare data is often fragmented, which limits organizations’ capacity from reaching meaningful insights. For this reason, P4P’s claims analysis uses Business Intelligence to interpret and present data using interactive visual dashboards. P4P’s sophisticated BI and AI tools associate disjointed provider, member/patient, claims, product, and service data. Our data integration allows our clients to thoroughly examine their business concerns by asking probing questions of Who, What, Where, When, and Why. Our 24-7 access through any web-enabled device, allows our clients to have the freedom to manage their business, on their terms.
Recommendation, planning, and implementation
P4P provides a complete Assessment Report in paper and electronic formats for an intuitive navigation to critical findings. P4P’s Assessment Report includes the following:
- Executive Summary
- Preface
- Table of Contents
- Assessment Overview
- Individual Metric Findings including;
- Priority Level (client force-ranking)
- Overall Risk Assessment (Red Light, Yellow Light, Green Light)
- Review Methods Used
- Requested Documents
- Summary Findings (Document Review, Survey Results, Graphs, and Summary)
- Conclusions
- Identified Opportunities
- Recommendations
- Overall Conclusion
- Appendices
Our findings from each metric are used to develop alignment recommendations. For advice requiring further development and planning. P4P provides on-going support through implementation.