Payer/Provider Integration Model
Integration between a payer and a provider can take many forms, from shared governance to aligned incentives to coordinated care delivery. How far to take it, and where, depends on what each organization is trying to achieve. PPIM gives partners a clear way to see where they stand today, and where closer integration would create the most value for their own strategic goals.
The Provider-Payer Integration Model (PPIM)
The Model views integration between providers and payers across seven domains. Each domain is supported by a series of specific functions that can be scored on a scale along a spectrum:
At Odds: a function operates separately or even at cross purposes between organizations
Coordinated: the entities act independently, even with different processes and tools, but communicate to remain in sync
Aligned: the entities have common capabilities and work toward common goals and incentives
Integrated: the partnership is tightly integrated to create new value together
PPIM was shaped by executives with experience in integrated delivery systems of all types around the country, so the domains and criteria reflect how these organizations actually operate.
The Domains Include
Leadership & Governance: Do our leadership and governance structures support our integration goals?
Clinical & Care Model: Are we delivering care together?
Data & IT: Are our systems connected in the ways that matter?
Financial & Payment Models: Are we rewarding the right behaviors?
Growth & Market Strategy: Are we growing together?
Operational & Administrative: Are our teams executing together day to day?
Consumer & Provider Experience: Do people experience coordinated care?
How it works
Assess and Score. SSX advisors meet with leaders in your organization and any partner organizations involved to develop a baseline of integration across all seven domains
Align and Target. Agreement on where advancing integration creates the most value for your specific goals.
Roadmap. A multi-year plan of specific initiatives to reach the desired state.
Remediate and Measure. Progress tracked against key metrics, with the roadmap updated as conditions change.