Consulting - ImpactValue-based care program design for a large UAE health insurer
Client
Leading Health Insurer in the UAE – SVP Clinical Innovation, Chief Medical Officer
The Challenge
The client has a mix of commercial offerings and TPA (third-party administration) services provided to government entities in the country.
The client had made a strategic commitment to improving overall population health, clinical quality, and managing rising healthcare costs that had grown significantly over the preceding decade.
To support this strategy and respond to market factors, the client asked Emica to design and roll-out a pay-for-quality program for large hospitals, clinics, and key specialties. The goal was to assist in the transition away from a traditional fee-for-service reimbursement model to rewarding providers for achieving defined quality targets.
Our Approach
- Provided SME input – in partnership with our partner- on value-based care program design, clinical quality and reimbursement methodologies. This facilitated an accelerated program design period of <12 weeks from concept to ready-to-launch.
- Designed and helped develop the program framework as part of a multi-stakeholder process, including the client’s clinical, operational and functional leaders. The design was built upon detailed analysis of client spend to determine the right focus areas for the quality program.
- Designed a provider quality assessment process to complement the claims data-driven quality framework and to enable a holistic assessment of provider capability and performance.
- Developed a pay-for-quality scoring calculator, payment calculator, and program dashboard to be leveraged by the client and providers. The Emica team also provided guidance for the scripting of new quality metrics to be measured as part of the program.
