From an access problem to a payer product
Most of these ideas sit on one path. A health system that follows it turns a capacity problem into something a payer will build with.
- 1Sufficiency RazorDecide where each need belongs.
- 2Capacity Creation AssessmentFind the capacity you already have.
- 3Virtualized fragmentationBuild one front door.
- 4Carry the Complexity testPut the routing work on the network.
- 5Analyst Rerun TestProve the value in the payer's terms.
- 6Attribute-Steer-Pay testShape it into a product a payer buys.
- Sufficiency Razor
- Care should use the lowest level of clinical intensity that can safely and reliably achieve the desired outcome. Includes cost per resolved clinical need.
- Capacity Creation Assessment
- A screen of a practice's office visits against the conditions that can be safely treated in a lower-cost setting, sized in physician hours freed.
- Virtualized fragmentation
- What a health system builds when each service line launches its own digital front door: the patient still pieces the journey together, now across apps and portals.
- Carry the Complexity test
- Who is doing the work of getting the patient to the right care? When it is still the patient, the network has more work to do.
- Analyst Rerun Test
- A value model is ready for a payer when the payer's own analyst could rerun it from your documentation and land in your range.
- Attribute-Steer-Pay test
- Whether an access or cost solution is a product a payer can attribute members to, steer members toward, and pay for.
- Reach-Role-Measure-Capture test
- Four questions to ask of any capability your EHR vendor promises before you wait for it, build it, buy it, or partner for it.
- 3x Price Test
- Run any AI business case at two and three times today's vendor price before you sign.