Business Driver

The Value-Based Care (VBC) movement is transforming the healthcare industry in pursuit of improved outcomes and lower costs for patients. Our Client, a healthcare insurance company, recognized this growing trend in the market and wanted to expand their VBC program with four goals in mind: improve quality, realize cost reduction, remain competitive in the marketplace, and improve payer-provider collaboration. The VP of Health Network Services asked Trexin to lead a cross-functional team to develop an actionable plan to attain these goals, including an assessment of both the national VBC market and the challenging contrast of local urban and rural markets.

Approach

Using a 12-week timebox, Trexin applied our 3-phase Assessment, Strategy, and Roadmap methodology, a strategy execution framework to an actionable, stepwise plan to improve capabilities necessary to achieve declared business goals. Compared to other approaches that simply assume an implicit or widely accepted link between change initiatives and business goals, the ASR forces a top-down discussion that explicitly connects business goals to individual business capabilities (people, processes, & technology).

The purpose of Phase 1 was to establish one set of business goal, strategy, and current-state capability facts. To do so, Trexin interviewed leadership, reviewed existing documentation, and held discussions with key external partners in the insurance broker, provider, and larger employer group community. To assess the national and local marketplace, Trexin analyzed industry publications and spoke with industry SMEs.

In Phase 2, Trexin led the definition of a future-state vision for VBC, including a conceptual architecture and high-level design, followed by a gap analysis against the current state. Through conversations with stakeholders, alignment was then reached on the role of payers in a VBC world, including an investment hypothesis for VBC.

In Phase 3, the team then defined a set of achievable projects to close the gaps. A business case and cost-benefit analysis were also developed using detailed cost estimates for each project and projected savings from implementing a successful VBC program. With VBC still in its infancy, establishing expected savings was challenging but was still possible with assumptions and historical analytics.

Results

Given our Client’s initial foray into VBC and the current readiness of providers in the local marketplace, the strategy and roadmap focused on care coordination, analytics, and provider change management as the lynchpins of the future VBC program. As our Client moves forward on the VBC transformation, they now have a customized 3-year investment roadmap to guide their activities. The detail provided in the roadmap will enable them to successfully implement an expanded VBC program, while remaining flexible to respond to market evolution.