Provider Services

Enterprise Strategy
Pricing Strategy Development
Payer Strategy Development
Payer Negotiation Strategy & Analytical Support
Innovative Payer Partnership Development
Managed Care Performance Transformation
Value-Based Strategy & Contracting Support

Payer Services

Provider Network Development & Management
Innovative Provider Partnership Development
Value-Based Program Strategy
Insurance Product Development

Leading a Managed Care Performance Transformation for an Academic Health System

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An academic health system was concerned about the performance of its managed care organization.  The new leader of the managed care team was looking to optimize its organization's performance including overall outcomes achieved, effective stakeholder management and efficient decision-making processes.  The organization asked for support in leading a performance transformation for the managed care organization.


To understand the current situation, Ridgeline conducted interviews with executive leadership and the managed care team.  Informed by these interviews and a review of documents and processes, we completed a managed care performance diagnostic to assess core capabilities across a variety of domains.  After socializing our findings with the organization’s leadership, we facilitated a process to refine which initiatives should be prioritized for improvement efforts.  Partnering the managed care organization at all levels, we helped to implement new processes and tools to develop capabilities to drive stronger performance. 


As a result of this effort, the organization achieved a higher level of overall performance including increased efficiency.  The organization implemented a best-in-class contracting process to optimize negotiation preparation and outcomes.  Through collaboration with the legal team, a prioritized ‘PARU’ contracting framework was developed to ensure an efficient contract redlining process.  Further, streamlined communication forums and decision-making processes were implemented which enabled the team to focus their attention on negotiation efforts and achieving better results quickly.