We will collaborate with your team to understand your deliverable, map out an approach given your timeline, marketplace dynamics etc. and effectively implement ensuring your success. Our experienced staff has payor and provider experience making us uniquely qualified to understand the marketplace, bridge the gaps and anticipate your needs.
Payor Approach
Payors are challenged with doing more with less. We can serve as an extension of your network development team and help you:
- Expand into new markets
- Optimize your current provider network
- Move into value based contracting or a Primary Care Medical Home model
- Develop and build a new network
- Comply with regulatory requirements
- Perform operational activities such as Medicare filings, HSD table and provider relations support
Provider Approach
Providers are moving into the Payer world. Our experience in working for and with Payors makes us uniquely qualified to help you:
- Develop and implement a Payor Strategy
- Build a provider network
- Optimize a current provider network
- Move into value based contracting or a Primary Care Medical Home model
- Comply with regulatory requirements
- Help you become a Payor
To guarantee that its members receive appropriate, quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process.
In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry.
A Comprehensive Solution With Four Key Areas of Focus:
Speed To Market – Milestones met, providers engaged, and systems loaded. Southwest Medical's surge of teams and technology enables clients to meet aggressive RFP application requirements.
Cost Efficiency – Data focus and real-time metric reporting enable Network Development teams to assure that resources are continually focused on filling gaps needed to meet adequacy requirements for the milestone goal.
High Performing Networks – Network status visibility and prioritization of providers during development enables competitive negotiations, well priced networks, and ability to monitor actual vs. benchmark targets.
Provider Relations and Branding – Engagement with community providers and facilities establishes client’s value proposition and provider relationships to facilitate market penetration.