Transformative Strategies for Medical Management Delivery
Striking the balance between delegation and integration
When healthcare organizations are moving fast, staffing challenges can delay success with key programs. If health plans lack bandwidth or expertise—or struggle to hire qualified, experienced staff—some speed service to their members by turning to delegated models that fully outsource a function or program to an outside entity. While this type of subcontracting may seem like an easy solution, it has enough challenges that many organizations are now turning to a hybrid, insourced model that integrates third-party resources within its operations.
What model would work best for you?
“Not only do integrated models help us address a specific need or gap in our ability to execute, but having third-party resources integrated with our team helps us pivot and manage change. You’re bringing other people in that have different subject matter expertise and may have a different cultural perspective to drive things in a different direction.”
– Dr. Christine Messersmith, CMO, Denver Health Medical Plan
Delegated Models Ease Implementation
With delegated models, an organization outside the health plan becomes responsible for your members, operating on your behalf for a specific function or program and accountable to mutually agreed-upon performance metrics. This can bring some peace-of-mind when you need to bring up a program quickly and you don’t have the expertise and/or staffing to make it happen.
However, delegation pushes those programs and activities out of your immediate circle of control, severing that close connection that helps you keep your finger on the pulse of your membership. Challenges include:
Poor visibility into real-time data, preventing timely analysis and reporting
Fragmentation of tools and data that creates siloes and complicates information sharing
High oversight requirements to ensure compliance
Maintaining agility to react to business and market changes
No control over quality service delivery
Lack of knowledge transfer to build in-house expertise
For some, these challenges are enough to search for an alternative solution.
Integrated Models Combine Speed-to-Service with Flexibility
Many organizations find that having an integrated team—additional resources to augment your in-house staff or a complete insourced plug-and-play team—provides the most flexible model to not only speed services to your members, but also weather the changing healthcare landscape.
If your goal is to manage the function in-house to maintain that close member connection, integrating subject matter experts directly into your team can help you build up your expertise over time and get your team ready for self-sufficiency. This approach also ensures that you have experienced resources fully committed to your plan, dedicated to the work that needs to be done for the benefit of your members.
Working directly in your systems, the experts can help you set up your systems and build the policies, procedures, workflows, and staffing to operate efficiently and effectively. As a bonus, once full responsibility is handed back to your team, you’ll still have a backup plan with additional resources who have direct experience in your operations you can rely on when turnover is high or you need to bring up a new program.
This approach builds agility into your strategy, making your organization more resilient to change and enabling you to quickly pivot when market and business conditions evolve.
“It feels very much as if Toney employees are our employees. They are fully integrated into our processes and our workflows—we work very closely together in a unified model.”
– Dr. Roberta McNeill, CMO, US Family Health Plan (a TRICARE option)
Toney Healthcare Brings Expertise, Efficiency and Empowerment
Toney Healthcare offers deep expertise in all areas of medical management, and can integrate with your team to help you achieve your goals for all plan types and lines of business. Whether you need leadership, staffing support or complete teams, our highly experienced clinical resources are all appropriately licensed—with health plan expertise—and can be quickly deployed to support your medical, behavioral health, and specialty programs. We work in your systems, empowering you with complete visibility and control of all program activities and outcomes and are fully accountable to your KPIs.
Toney Healthcare’s team of experts is ready to help you address your utilization, care and behavioral health resource needs with plug-and-play health management services and expertise so you get the help you need, fast—and without HR headaches.