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A Creative Health Concepts core competency is supporting payors in achieving their provider contracting goals.
- Network analysis is performed by data mining proprietary and public databases to ensure key providers are contracted and competitive networks are built.
- Claims data analysis is used for benchmarking, contract modeling, identifying utilization trends, detecting high cost providers and/or services.
- Negotiations are conducted to attain the most advantageous contract rates and language provisions
| Payor Types | |
| HMOs, PPOs, TPAs, ASOs | |
| National or local market organizations | |
| Medicaid, Medicare Advantage, Commercial, Worker Comp and No Fault | |
| Behavioral Health or other Specialty Networks | |
| Network Development Services | |
| Introduction into new markets and territories | |
| Product expansion into existing markets | |
| Expansion of existing markets to meet competitive landscape | |
| Development to meet more cost effective network options | |
| Contracting Models | |
| Fixed rate fee for service | |
| Risk | |
| Pay for performance | |
Another core product of Creative Health Concepts is network development and contracting for Medicaid, Medicare Advantage and Commercial insurers nationwide including HMOs, PPOs, FFS, Workers’ Comp and No Fault, Behavioral Health and other specialty networks using:
- percentage off charges
- case rates per diems with or without carve-outs
- flat rates for technical and/or professional components
- inpatient/outpatient charges in conjunction with hospital
- fee-for-service contracting
- primary care physician capitation
- full or partial risk contracting
- pay for performance
Network Development Projects by Type:
Ancillary Catagories
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