Maraya Estevez
Internal Provider Relations Representative - Health Network One at Therapy Network - Fort Lauderdale, FL, US
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Therapy Network
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CHALLENGEThe common tools and techniques for a health plan to drive cost containment and operational efficiency are ineffective in satisfying the need for quality, accessible care. Common results of this imbalance are overtutilization of clinical services or denial of care to patients - a traditional win-lose scenario.SOLUTIONHealth Network One addresses the imbalance by managing the value chain, from utilization management to provider engagement to claims reimbursement, under full risk. Our focal point is changing providers' compensation to eliminate their incentive or ability to overutilize clinical services. In parallel, we reduce the provider's administrative burden and provide performance incentives.RESULTSThe outcome is a material and tangible reduction in costs for the health plan, a dedicated and loyal network of providers, and a satisfied patient membership. A rare win-win-win for all three constituencies.