Richard Bajner leads the Value Transformation segment of the Healthcare practice. He works with leading payers and providers in developing their integrated network, product and pricing strategies, including the design and implementation of Accountable Care Organizations (ACOs) and bundled payments.
Rich often facilitates payer and provider long term partnership opportunities, to create new frameworks that deliver higher quality, more efficient services within a market. His experience spans more than a dozen of the largest ACOs and over 200 facilities. Rich also advises providers, commercial payers and state Medicaid agencies on designing and implementing payment models that align incentives to achieve improvements in care delivery.
Provider and Payer select engagement highlights:
- Managed design and implementation strategy for numerous ACO pilots across the country, including identifying care improvement opportunities, engaging post-acute providers in care coordination efforts, building physician networks, and developing shared savings models to reward high performance.
- Led more than 200 providers in assessing and developing applications for Medicare’s Care Improvement for Bundled Payments pilot, and worked with multiple providers in their design and application to Medicare’s Shared Savings Program.
- Developed a managed care strategy for national provider network, including the development of payer specific negotiation strategies, creation of regional operations teams, and imbedding a standard set of tools across markets.
- Designed a shared savings risk-based payment model on behalf of a large statewide commercial insurer and multi-hospital system, that incentivized lower year over year reimbursement trends and improved quality of services.
- Developed tiered pricing strategy for a major commercial payer, resulting in a new framework for incentivizing and rewarding high quality, cost-efficient care.
Performance Improvement select engagement highlights:
- Assisted hospital providers in quantifying potential short and long range cost savings resulting from both traditional variable cost opportunities, as well as savings opportunities likely to result from changes in incentives from new payment models. Analysis quantified margin gap to occur within 3-5 years.
- Developed a hospital-side computer simulation model of a 380 bed replacement space plan, which assisted hospital management in testing the plan to ensure adequate work flows, room counts, and staffing. The model was presented as a National Best Practice at a national conference.
- Engaged a 40-member orthopaedic surgeon practice to care for patients across an episode through a combination of appropriate post-acute utilization and alignment with high quality skilled nursing facilities. Designed a gain-sharing model to share more than $450k in annual savings between the facilities and more than 35 physician partners. An overall cost savings of 15% was achieved.
Rich is Lean Six Sigma certified and is a frequent speaker and writer on the integration of payment and clinical transformation.
Rich was recently recognized by Consulting magazine as a Healthcare Industry "Rising Star of the Profession", honoring outstanding talent under the age of 35. Rich was selected due to his ability to navigate through exceptional change as the marketplace redefines value in healthcare.