Managed care plan needs leadership to improve profitability to continue serving its community of armed service members​

Picture this...

You’re Uniformed Services Family Health Plan (USFHP), a managed care plan providing TRICARE benefits on behalf of the Defense Health Agency (DHA), the healthcare arm of the Department of Defense (DoD), for dependents of active-duty service members, and armed services retirees and their families. After your parent organization, Saint Vincent's Catholic Medical Centers of New York (SVCMC), emerges from bankruptcy, you face several operating struggles. First, your contract with the DoD is set to expire and failure to gain renewal would prevent you from continuing operations. Second, the DoD contract limits the number of possible enrollees in your program; you need service area expansion approval from the DoD. Third, your plan competes with other DoD healthcare offerings provided by managed care subcontractors and military treatment facilities, among others. Finally, you face profitability struggles: your operating revenues are derived from capitation payments. These rates are established annually after negotiation between the DoD and your designated providers. Per the DoD, you’re obligated to provide to members certain healthcare services without regard to the costs incurred.​

You turn to Accordion.

We serve in an interim leadership capacity to help transform your operations and improve profitability. We:​

1. Drive operational and financial improvements. We:​

• Negotiate annual capitation rate increases of 2% to 6%.​
• Increase plan membership by approximately 27% over eight years, hitting an all-time high.​
• Secure designated provider status for your service area with the DoD.​
• Implement a new marketing incentive plan, aligning initiatives directly to capitation rates.​
• Develop a new enrollment database and revamp payment to collect timely enrollment fees on a recurring basis. ​

2. Improve clinical care operations: We:​

• Expand population health initiatives and Value-Based care programs. ​
• Improve HEDIS metrics, including reimplementing a data warehouse reporting infrastructure to improve data quality.​
• Implement technology solutions to improve scores in various HEDIS metrics. ​
• Deploy cloud-based EMR system, improving clinical efficiency and patient care at two family practice clinics.​
• Develop a heat map tool to better align provider network with enrolled and eligible members.

Your value is enhanced.

Your contract renewal and rate increases enable ongoing, now-profitable operations. In addition, your new payment system is hailed as a “Model Program” by the DHA and used as a prototype for other health plans.