Richard Bajner leads payer and provider teams within Guidehouse’s Health segment. As a distinguished healthcare expert, he has led more than a dozen of the largest accountable care organizations (ACOs) and more than 200 facilities in designing, developing, and implementing integrated networks, as well as payer and provider product and pricing strategies.
Bajner facilitates long-term payer and provider partnership opportunities to create new frameworks that deliver higher quality, more efficient services within competitive markets. He also advises providers, commercial payers, and state Medicaid agencies on designing and implementing payment models that align incentives to achieve improvements in care delivery. As a Lean Six Sigma certified thought leader, Bajner is also a frequent speaker and writer on the integration of payment and clinical transformation.
Provider and payer 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 the Medicare Shared Savings Program.
- Developed a managed care strategy for a 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 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 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.