Top 5 Considerations When Developing a Resource Strategy
Whether you lack bandwidth or expertise, resource challenges can delay success with key programs no matter what your line of business. Finding a solution that delivers the right services with qualified, experienced staff and on your terms can be difficult. Most companies turn to either a delegated model that fully outsources a function or program to an outside entity, or a hybrid, insourced model that integrates third-party resources within its operations. What model is right for you?
As you’re planning your resource strategy, ask yourself these questions:
What is your long-term goal? If you’re okay with a hands-off approach, a delegated model may be the way to go. But if you eventually want the expertise in-house, the fastest path would be to integrate experienced clinicians directly in your operations to bridge any resource gaps and empower your team to become the experts. The best partners will add value along the way, helping you tailor your processes and workflows to improve your model of care.
How important is the personal touch? Delegation adds distance—the party responsible for member well-being and your plan’s values is no longer the party directly accountable for care. This degree of separation—plus after-the-fact reports and siloed data—make it difficult to maintain a close member connection and delays critical information that can affect your quality performance.
How does your organization manage change? Changing course can be a lengthy process, particularly if you lack control over how a program operates. Flexibility to quickly react to business and market shifts will help you be more responsive to members and other stakeholders and better retain market share.
Do your systems and data need to be integrated? Clinicians and case managers tend to want all information in one system so that they have up-to-date information for decision-making. Delegated models often use different tools so information sharing may not be smooth or timely. If your goal is seamless, real-time information availability, consider an integrated model that uses your systems, workflows and processes so everybody has the right information when they need it.
Does your plan have unique regulatory requirements? Some plans (e.g., TRICARE) are sensitive about delegated relationships and have additional stringent oversight and other requirements that may affect your staffing choices. A fully delegated model, for example, may receive additional regulatory scrutiny than an integrated model that works within the plan’s systems for seamless data exchange and that doesn’t require additional encryption and security.
Toney Healthcare Empowers Plans with Trusted Expertise and Clinical Resources
Toney Healthcare offers deep expertise in all areas of medical management, and can integrate seamlessly with your team to support 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.
