Part I: Establishing PI benchmarks is highly complex
About a year ago, I was discussing this question with several PI industry thought leaders.
Some of the largest health plans and vendors had already attempted to develop financial benchmarks for PI – but efforts had stalled.
Existing performance targets are skewed. 5-7% savings as a percentage of medical spend or broad ranges of savings PMPY are ineffective without a standard approach to defining, calculating, and segmenting the metrics.
Standardization is very difficult. Payment integrity programs vary in structure, maturity, and methodologies. Plans are hesitant to share performance metrics.
We determined that these challenges underscore the need for a highly disciplined, collaborative approach focused on these core values:
Start with the fundamentals. An essential first step is to develop standard definitions and calculations for PI programs and benchmarks. These norms will then be applied to enable comparable metrics.
Collaboration is critical. A Working Group of subject matter experts will share proposed guidance, gather industry-wide feedback from all types of plans and vendor partners, and publish recommendations.
Progress over perfection. Every PI program is structured differently. While guidance may not fully align with a plan’s existing data systems or reporting, we will provide a flexible framework and support to drive progress.
Guided by these core values, the Working Group is focused on standard definitions and calculations for Savings PMPM. Read more about our proposed guidance in Part II of this series.
Questions or feedback? Contact Natalie Clayton at [email protected].