•Provider Network Development
–Western Providers, Inc. network of health care providers are the preferred panels of numerous health
plans serving citizens of western South Dakota. The network provides discounted pricing for health plans
primarily based on improving volume for participating providers
•Provider Education
–Western Providers sponsors provider education for quality and cost management
•Credentialing
–Credentialing is conducted through participating hospitals, and through an independent credential
verification organization
•Cost Management
–Messenger Model
•For employer self-funded health plans, the provider network is developed through a legally qualified
“messenger model”, an independent pricing process designed to obtain competitive provider costs.
–Risk-based products
•For some health plans, both employer self-funded and insured, a Western Providers panel is
developed using capitation or other financing approaches that provide incentives for physicians and
hospitals to manage costs