Value Based Care in the Dental Industry

Challenge

A national dental carrier was seeking expertise to support the development of an innovative model of contracting with dentists. The vision was to incent value based dental care practices in order to improve care and reduce costs.

Solution

Patina proposed a unique partnership that would leverage our network of dental and medical expertise from an insurance carrier perspective, as well as from the provider and care delivery segments of the industry. Patina’s ability to leverage professionals with real world experience developing, launching and managing successful value based programs enabled our client to accelerate its development work and avoid many of the mistakes that were made in medical industry models. Experts from Patina supported the development of an initial strategic framework, which included financial modelling, contract design, and performance incentives. Our Professional network was then utilized to support program design and implementation, including technology, contracting, analytics, and provider contracting support.

Outcomes

This multi-year and multi-discipline initiative resulted in a successfully launched, national Value Based Dental Care program. It includes a range of risk models and quality initiatives to meet market needs in both commercial and government segment programs.

Our client said, “We’re in a stronger position to implement value-based programs in our organization after partnering with Patina. Value-based pricing isn’t prevalent yet in dentistry, but it is an emerging opportunity and our team needed to ensure we’re able to leverage industry experience in the design and implementation of successful programs. To help develop a wholistic approach, Patina’s experts brought their experience working with both insurance, as well as provider-based programs in commercial and government Medicaid and Medicare models. Patina worked in concert with our team to develop and implement contracting models, communication strategies, and operational metrics. Our internal team is progressing with our long-term implementation plans for value-based care with confidence.”

Pharmacy Integration

Challenge

A national health insurance carrier engaged Patina to support a strategic redesign, improvement in cost of goods sold (COGS), create operational efficiencies, and enhance reporting and analytics, as well as support the implementation of its pharmacy benefit manager (PBM) strategy. The carrier was seeking senior executives with proven, deep industry experience in developing and launching this approach in a national multi-line carrier environment.

Solution

This multi-year engagement has included an assessment of current operations and financial performance of all pharmacy programs, services, and vendors. Patina assisted with the development a five-year strategic plan to redesign and implement PBM operations including financial modelling, technology assessment and transformation, underwriting, organization structure design, contracting strategy, and operations integration and management.

Outcomes

The engagement is in its implementation phase and projected to significantly improve the competitive position and financial performance in all aspects of PBM operations. The project is on course to produce a multi-million dollar bottom line improvement, with a minimum of a 100:1 return on investment.