A National Manufacturer Strengthens its Multi-Market Direct Contracting Strategies

What the Company Found: 

As their benefits leader put it: “These reports give us, right up front, the accuracy and reliability of what we’re seeing.”

The analysis also revealed wide pricing gaps across markets that the employer’s claims data alone couldn’t reveal, and uncovered differences in care quality that the employer had never before seen. “There’s no good price for unsafe care,” the employer’s benefits leader said.

How the Company Leveraged the Findings: 

1. Care quality assessments on a provider-by-provider basis. The employer was finally able to assess what it paid for the quality of care its workforce received—a capability its benefits leaders previously lacked. 
2. Enhanced direct contracting strategies. The employer could analyze its data down to the CPT code level, giving it more complete frameworks for RFPs and negotiations, as well as the ability to set quality incentives and year-over-year improvement goals. 
3. Validation of its vendor’s work, independently verifying when its benefits consultants were delivering what they’d promised. 
4. Specialty-specific insights. As the employer’s benefits leader put it: “This helps me understand, by category, by specialist, how a group is operating from a quality perspective. It allows me to have very good conversations with our partners on not only how we might improve, but how we might set incentives to see year-over-year change.” 
5. Identification of new partners. The employer found additional contracting opportunities for specific specialties and procedures.

The National Advantage: 

“Because we’re a national employer, I’m able to look across markets,” the company’s benefits leader said. “I’ve got more context in what I’m seeing. To see the wide gaps in pricing, to be able to see it beyond just what our claims are telling us, has been really profound.”

The Impact on Negotiations: 

“This view is like none other I’ve ever seen before,” the company’s benefits leader said. “It gives me a lot of talking points when I’m going into any kind of discussion, either with a health plan, or with our providers, or with our direct contracting partners.”