Managed Care and Health Plan Services

For health plans and risk-bearing organizations, we focus on moving payment mechanisms from volume to value by identifying the challenges that your organization is currently facing. These may be in your provider network, your regional market, or even within your own enterprise. We define, capture, and deliver opportunities and recommendations that match your financial and operational objectives. We believe in performing analysis of available underlying data to build a practical roadmap for an implementable solution. Our approach is hands-on; we will partner with you to achieve meaningful and lasting results. In the process, transfer knowledge and tools, leaving your organization stronger than when we arrived.  Services for health plans might include: 

  • Overall strategy, strategic program analysis (ROI), and strategic planning activities

  • Process analytics, process re-design and process/performance improvement

  • Operational automation and system efficiency

  • Business process and IT enablement

  • Technology assessment, strategy/selection and system replacement

  • Program development and project management

  • Risk analysis, management, and mitigation

  • Compliance and regulatory matters

  • Medicare Star rating improvements

  • Payer-provider collaboration and integration

  • Post-merger and acquisition integration and benefits realization

  • Consumer/member engagement and consumer/member experience improvement