Healthcare Industry - Payer

The transformation with which payers are contending is being influenced from a variety of sources including: healthcare reform and compliance mandates, changing health information technology, increased pressure to compete while maintaining low premiums, and improving consumer and member engagement.

Top-performing health plans seek out innovative thought leadership and advisors who understand the industry and business model intimately. They partner with high-performing teams who know best practices as well as how to meet unique organizational needs.

Whether your goal is to scale and take your care management program digital, solidify internal processes and quality reporting to enhance STAR ratings, or create new tools to help extend sales and member engagement efforts, we can help.

In Which Area are You Seeking “Possibility Thinking” and Successful Execution?

We have an in-depth understanding of healthcare and the health insurance industry. Over the years, we’ve helped our health plan clients create significant operational, financial, sales and member service strategies and solutions through our dedication to practical, collaborative relationships and successful execution.
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Business Transformation

Possibility Thinking + Efficient Processes
  • Care management and resource optimization
  • Eligibility and enrollment processing
  • Portal design, process, and integration
  • Member engagement via digital and mobile
  • Enterprise content management
  • Performance, quality, and cost reporting
  • Stars, NCQA, HEDIS reporting, and management
  • Data collection and analytics
  • Revenue cycle management
  • Claims submission optimization
  • Reimbursement and cash flow improvement
  • Data collection and reporting methodologies
Process Engineering & Improvement
  • Care management and resource optimization
  • Eligibility and enrollment processing
Customer Experience
  • Portal design, process, and integration
  • Member engagement via digital and mobile
  • Enterprise content management
Compliance
  • Performance, quality, and cost reporting
  • Stars, NCQA, HEDIS reporting, and management
  • Data collection and analytics
ROI & Cash Flow Optimization
  • Revenue cycle management
  • Claims submission optimization
  • Reimbursement and cash flow improvement
  • Data collection and reporting methodologies
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Digital Strategy & Execution

Business Goals + Scalable Technology Realized
  • Supporting the speed of technology
  • Real-time or transactional systems
  • Internet of Things (IoT) architecture
  • Systems integration
  • Creation of profitable relationships
  • Differentiated customer experiences
  • User experience and design
  • Tailored mobile apps
  • Integration of business intelligence and analytics into mobile
  • Scalable data platforms
  • IoT support
  • Customer and performance visualization
  • Proprietary architecture accelerators
  • Portal-in-a-Box
  • Mobile sales accelerator platform
Digital Architecture
  • Supporting the speed of technology
  • Real-time or transactional systems
  • Internet of Things (IoT) architecture
  • Systems integration
Digital Customer Experience
  • Creation of profitable relationships
  • Differentiated customer experiences
  • User experience and design
  • Tailored mobile apps
Customer Analytics
  • Integration of business intelligence and analytics into mobile
  • Scalable data platforms
  • IoT support
  • Customer and performance visualization
Digital Program Execution
  • Proprietary architecture accelerators
  • Portal-in-a-Box
  • Mobile sales accelerator platform
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BI & Analytics

Harnessing + Activating Data
  • Consumable and actionable reports
  • Metrics creation
  • Data optimization
  • Integration and optimization of source systems
  • Current system mapping
  • Improvement planning/gap analysis
  • Compliance and policy strategies
  • Improvement of system performance
  • Development of data architecture plans
  • Non-compliant system elimination
  • System migration to the cloud
  • System compliance strategies

  • Predictive population health models
  • IoT strategies for predictive medicine
  • Creation of models to improve patient care

Reporting Solutions
  • Consumable and actionable reports
  • Metrics creation
  • Data optimization
End-to-End Data Systems
  • Integration and optimization of source systems
  • Current system mapping
  • Improvement planning/gap analysis
Strategy Development
  • Compliance and policy strategies
  • Improvement of system performance
  • Development of data architecture plans
Modernization / Mobilization
  • Non-compliant system elimination
  • System migration to the cloud
  • System compliance strategies
Statistical & Predictive Modeling

  • Predictive population health models
  • IoT strategies for predictive medicine
  • Creation of models to improve patient care

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Office of the CIO

Bridging Gaps within C-Suite
  • Managed testing
  • Mobile testing
  • Test automation
  • Test data management
  • PMO assessment
  • Portfolio rationalization
  • PMO roadmap
  • PMO launch/build
  • PMO organizational transformation
  • PMO adoption assessment
  • Agile readiness assessment
  • Agile adoption roadmap
  • Agile organizational change support
  • Agile SDM portal
  • Agile mentoring
  • Portal development
  • Custom application & architecture
  • Requirements improvement and QA practices through zero-defect application development, testing & support
QA/Software Testing
  • Managed testing
  • Mobile testing
  • Test automation
  • Test data management
Project Management/PMO
  • PMO assessment
  • Portfolio rationalization
  • PMO roadmap
  • PMO launch/build
  • PMO organizational transformation
  • PMO adoption assessment
Agile Transformation
  • Agile readiness assessment
  • Agile adoption roadmap
  • Agile organizational change support
  • Agile SDM portal
  • Agile mentoring
Application Development
  • Portal development
  • Custom application & architecture
  • Requirements improvement and QA practices through zero-defect application development, testing & support

Payer Trends Where We Can Make a Difference

For our health plan clients, we see six priority industry pressures and trends:

Managing Compliance

While efforts are afoot to align and simplify measurement requirements, managing compliance has become an onerous necessity. Performance, quality, and compliance like NCQA, STARS, and HEDIS dominate payer priorities.

Optimizing Care Management

Clinical data is driving care management and health plans want a clearly documented path for how managing populations will benefit them. What’s clear is that all emerging payment models require robust and streamlined care management programs.

Adapting Payment Models and Population Health

Whether through incentivized plans, population health strategies, or accountable care models, health plans require innovative programs and improved processes to remain financially sound within a value-based care model. And, now that member engagement is a quality mandate, it’s vital to acquire, keep, and satisfy individual members while managing populations effectively.

New Players & Consumerism Choices

The healthcare market has new players and a dizzying array of choices for consumers. Health plans need to address the opportunities and risks around partnering or pursuing new markets and engaging members in new and innovative ways.

Managing Mergers & Acquisitions

Consolidating for efficiency and stability is driving transformation. When combining operations, innovations, technologies, and business practices, it is paramount that a thoughtful assessment and approach yield synergies and value rather than create more chaos and cost.

The Marketplace Effect

Surviving and thriving through the ACA exchanges takes a savvy financial plan for the short-term, as well as a tactical approach to realizing the value of participation.