Overview

Health plans nationwide are working to keep people healthy and slow the rise of health care costs. However, there are still opportunities to further improve the affordability and quality of health care.

Financial Management

Are the appropriate analytics and cost controls in place to effectively manage your risk?

Measuring, analyzing and controlling health care costs while increasing the quality of care provided to members are key components of program optimization. We can work with you to improve your balance sheet by evaluating your disease and care management programs, supporting consumer-driven and account analytics and reporting, and controlling pharmacy costs and prescriptions.

We analyzed a Medicare Advantage plan’s historical medical costs and found that an injectable drug was costing our client $40 million and driving their trend up by 5%. Mitigation planning and benchmarking led to an alternative treatment option that was promoted through clinical programs and ultimately reduced costs.

Network Optimization

Does your provider network meet your member needs from an access, quality and cost perspective?

The first step toward quality care is creating a quality network at equitable reimbursement levels. We provide competitor reimbursement analysis, contract analysis and modeling and contracting and pricing strategies.

Medical Management Design, Evaluation & Improvement

Is your medical loss ratio where it should be?

Significant investments are made in care management programs yet the value delivered varies dramatically. Our experts can evaluate how your population management programs are performing and, based on that information, help you develop and implement pay-for-performance plans and case, disease and utilization management programs with the ultimate goal of improving your overall member health.

We worked with one health care organization to deliver more than $5 million and 50 FTE in annual savings.

Prospective Payment Strategies

Are your payment reimbursement programs effectively working to reduce medical costs and ultimately slow rate increases?

The transition from fee schedule, percent-of-charge or per diem payment arrangements can be a formidable task. We provide process and system recommendations that help you make this transition and optimize your reimbursement policies.