A Regional Health Plan Creates a Shared Savings Product Solution

The Problem

A health plan needed to implement a new shared savings pricing structure for self-insured employers and establish a program to manage the conversion of all their products within this pricing structure. The process included the development of new support structures: business logic to define the products; development of a new claims calculator and billing system; contract language changes to incorporate the new pricing structure; development of a reporting system to track and display savings accrued; and training, sales support, and communication assets detailing the new pricing structure product portfolio for internal and external audiences. 

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The Approach

First, the Propeller team engaged with the technical teams to develop requirements for the component pieces of the new pricing structure and engaged with the business teams to identify the solution impact. The executive team was then consulted to align implementation plans with the organization’s strategic direction and PMO to establish the infrastructure to monitor project progress. Finally, a project governance structure was created including workstreams for key milestones, leads for each workstream, sponsors to support mitigation and decision making, and an executive sponsor forum for status reporting and decision making. 

Services Provided

  • Business & Operating Model Strategy
  • Data Integration & Vendor Management
  • Go-to-Market Strategy
  • Program Planning & Road Mapping
  • Project & Risk Management
  • Team Leadership & Development
Relevant Service Offerings
  • Operational Excellence
  • Payment Innovation
  • Experience

Value Delivered

Propeller successfully implemented a portfolio of six new and permanent shared savings product offerings and the data calculator to support the portfolio’s claims processing and billing requirements. All told, the project included 12 major workstreams across 18+ organizational departments and disciplines, with a governance process that included 30+ team members. Propeller ensured viability and ongoing portfolio expansion by helping onboard a program director and analyst. Further, Propeller developed a process for ongoing evaluation of future portfolio additions and program playbook. The new portfolio proved a key differentiator: it enabled the client to win a large competitive bid for a coveted prospect, created an additional $4M gained revenue, and helped the plan’s customers save money.