James Evans, vice president of Financial and Network Management at McKesson Health Solutions, discusses key investments for payers that want to be prepared for the shift to more accountable care.

Because they face a range of market innovations, such as health insurance exchanges, that will continue to be refined over time, payers are pursuing provider network frameworks and data management toolsets that will give them the agility they need to make the most of new opportunities. Reimbursement modeling and cost management solutions also help payers connect contracts to policies to reimbursemenategies. By building in clinical and quality information into payment systems and exposing this information to providers, payers can “work from the same scoresheet” as their providers.

It’s an exciting time to be in healthcare, but not an easy one. The pursuit of value-based healthcare is spawning an incredible rate of experimentation and innovation, at the same time relationships between payers and providers have become increasingly intertwined.

At the 10^th Annual World Health Care Congress, McKesson experts will be sharing insights into the key role that health information technology plays in facilitating transformation:

• On Tuesday, April 9, from 4:05 to 5:05 p.m., Dr. Emad Rizk, president of McKesson Health Solutions, will participate in a keynote panel discussion on the topic of “Healthcare Transformation Through Technology Innovation,” which will explore how health information technology helps create an interconnected, next-generation care model. Click here to download Dr. Rizk’s latest white paper on the topic, “Mastering Change: Succeeding in Healthcare’s New World Order — Part 1: Breaking Down Barriers, Building Collaboration.”
• On Monday, April 8, from 2:15 to 3:15, James Evans, vice president of Financial and Network Management at McKesson Health Solutions, will share his perspectives in a panel discussion on “Strategic Network Design Strategies for Payers and Providers.” Jim will provide insight to help health plans analyze their network design strategies, including preferred networks, tiered networks, and limited networks, among other topics. To hear an overview and Jim’s take on changing populations, access his WHCC podcast here. Or click here to download his latest e-book, “Network Management: Are You Ignoring a Critical Asset?”
• Douglas Moeller, MD, medical director at McKesson Health Solutions, will serve as a host and moderator of WHCC’s Inaugural Network and Contract Management Summit for Payers and Providers. This new summit brings together leading executives from both payer and provider sectors to discuss collaboration strategies supporting the increasing demands of payment and delivery reform.

Initiatives such as patient-centered medical homes, accountable care organizations and other value-based strategies are moving from pilot to production phase in the market. These initiatives typically involve more complex contractual arrangements between health plans and healthcare providers, which, in turn, require innovative methodologies for paying claims appropriately. However, even in traditional fee-for-service environments, claims processing is challenging. For such initiatives to enable affordable, accountable care with the greatest efficiency, health plans need to align their medical, benefit and contracting policies, then codify them in their claims systems. This ensures claims are paid consistently and accurately – without the time and expense of manual workarounds or adjustments to inflexible core systems

In this Webinar, Jim Evans, vice president of Financial and Network Management at McKesson Health Solutions, will discuss the ways in which plans first align their policies to drive value, then ensure that policies are reinforced during claims processing. In addition, he shares insights on strategies to move from fee-for-service to value-based care; the framework to use when aligning medical, benefit and contracting policies; and the role of claims adjudication in enabling innovation.

Listen to the Webinar recording here.

Four major market disruptors are thrusting network management into the spotlight for health plans: changing care delivery models, more advanced and value-based reimbursement models, demand for new products and benefit designs, and finally the health insurance exchange (HIX) timeline. Tight payer-provider partnerships, flexible technology and a more integrated approach to network management are the keys to success in a rapidly changing healthcare environment.

In this e-book reprint from Health Management Technology, Jim Evans, vice president of Network and Financial Management at McKesson Health Solutions, describes what can be achieved when health plans look at network management from a fresh strategic perspective.

(If your device does not support Flash, download a PDF here.)

In the final post of his Health Management Technology guest blog on December 20, 2012, Jim Evans describes the advantages that health plans can gain by optimizing the network management function, and offers some helpful advice for determining organizational readiness to do so. If you missed his first two posts, you can read about why the network management function is under pressure to evolve here, and about the best ways to integrate and automate provider information management, network design, contracting and reimbursement here.