New Reimbursement Paradigm

Today, nearly 1,000 accountable care organizations led by physician groups, healthcare systems and health plans serve approximately 25 million patients nationwide and that number is expected to grow significantly over the next five years.

However, the existing value-based care (VBC) model is extremely flawed.  Instead of removing the obstacles that hinder better patient care, policymakers and plans continue to add administrative and financial burden on providers.  This model is unsustainable and will not drive profitability for physicians or better patient outcomes.  Removing these obstacles is our charter at KoanHealth.

We help IPAs and ACO assess existing value-based contracts and network performance and identify specific targets for clinical and financial improvement. We work with clients to develop the right contract structures, provider mix, services, facilities and modalities – all coordinated and functioning at the lowest possible cost. We help providers gain a deeper understanding of the services needed to effectively manage populations, how those services are currently being delivered, and how they can be delivered more optimally—in network or through outsourcing.

From performance improvement to network optimization, we work with clients to develop and implement rapid-ROI value improvement initiatives. We begin with low-effort, high-value changes that increase revenue, improve quality, satisfaction and outcomes with minimal cost.

Specialized care companies

Koan Health also works with organizations and firms that are pioneering new ways to deliver high-value care for complex and chronic conditions. Specialty medical management companies and specialty accountable care organizations are taking on new accountability for enhancing care improving outcomes and reducing costs for a growing range of high-impact chronic conditions, including cancer, chronic kidney disease, end-stage renal disease and musculoskeletal pain.

In addition, firms are beginning to assume risk the management of specific situations—like emergency department visits and hospital readmissions—where patient education, intervention and follow-up can keep people healthier outside of high-cost care settings.

Accepting risk for specific conditions and situations requires in-depth knowledge of patients and current care patterns to design improvements—plus real-time tracking to monitor results and refine processes of care. Koan provides the comprehensive analytics specialty ACOs and medical management companies need to contract wisely, manage care effectively and most importantly—demonstrate clearly their value improvements in real time.