Services for Health Care Systems
Hospital systems and physician organizations are facing many new challenges. Payment for services is changing from fee for service to value based arrangements that often include taking risk. The Affordable Care Act is encouraging health systems to form “Accountable Care Organizations.” Insurance products on the health insurance exchanges are using narrow networks of hospitals and physicians. It is increasingly important for hospital systems and physician organizations to understand the insurance industry, the design and pricing of insurance products and the structure of the health insurance marketplace.
Prospective Health, LLC can bring deep health insurance expertise to assist you as you negotiate the new health insurance marketplace. Prospective Health can offer you the following services:
Accountable Care Relationships
Hospital systems and physician organizations are facing a unique set of challenges and opportunities in the new healthcare market. A new payment landscape is emerging that will require health systems accept risk for both quality measures and for total cost per patient. Accountable Care Organizations offer the opportunity for new relationships with both government and private payers and the potential to go to market directly. Success in this new landscape will require an understanding of the insurance industry. Whether negotiating a new contract under Medicare, Medicaid or private insurance, or fashioning your own product for the market, you will need to understand the product design, pricing, and marketing of insurance products. Even if you are just negotiating with existing payers, you need to understand their objectives and their business needs in order to negotiate successfully for your health system.
Paul von Ebers has extensive experience in designing and negotiating all types of contractual relationships between health plans and health systems. Paul has been on the health plan side of these negotiations for part of his career and on the health system side for another portion. He has worked through risk sharing, global budgets and quality incentive based systems. He is a keen strategist on how to achieve win-win relationships. Paul can help executive management teams clarify their objectives, create a plan for negotiation and implementation and create measurement systems for success.
Paul is also a seasoned health insurance executive who can explain the dynamics of the exchange and off-exchange markets. He can help you build a go-to market strategy if that is the path you want to pursue, or help you negotiate with health plans. Von Ebers can also provide interim leadership for an ACO strategy and help your system put the long term leadership team in place to put you on the path to success.
Strategic Planning Facilitation
Paul von Ebers is known in the health care industry as a thoughtful strategist who understands all aspects of health care financing. In addition to his senior management experience, Paul has also been a senior adviser to health insurance companies, hospitals and health care IT organizations. He is an excellent facilitator who will help a management group come to their own strategy. For health systems, Paul can bring the point of view and knowledge of the health insurance industry to planning for health systems. This will allow health systems to make plans with the knowledge of how the health insurance industry will react and how to operate in an ACO and risk sharing environment. He knows the industry, so he can ask the right questions, probe and pull suggestions from executive leadership teams without imposing his own views on the process. Paul has a passion for helping executive teams find and develop sustainable sources of strategic advantage. Finding these sources of advantage is the difference between having a good plan and a great one.