Provider Network Management (PNM) & Value Based Contracts
MCO Network Management Services
Actuarial review of capitation rates, bundle payment and fee schedules
Risk-Sharing Programs – modeling impact of ROI and gains/losses; operational readiness to bear risk
Value Based Care - contract review, covered services, KPIs dashboard, readiness review of risk bearing capacity, performance measurement
Utilization & Cost Comparison
Identify areas of opportunity
Network Efficiency
Validation of Network Optimization & Care Alignment
Provider Contract Modeling
Inpatient: MCG will develop provider contract modeling tools allowing user to model impact of per diem or DRG contracts with outlier and billed charge provisions
Outpatient: MCG captures all outpatient provisions for observations, same day surgeries, emergency room visits, Medical Part B drugs, laboratory and radiology services modeling impact of changes in reimbursements and fee schedule changes
MCG models captures impact of all hospital contract changes capturing the impact of one ore more hospitals on your entire network of providers.
Professional -modeling impact of fee schedule changes, comparison against Medicare RVUs