Industry Intelligence

From the implementation of CMS' expanded definition of supplemental benefits to the increasing awareness of social determinants of health, the healthcare industry is changing rapidly and will continue to change in the coming years.  We stay at the forefront of the healthcare political and regulatory landscape to provide guidance for effective strategies in this health care era.

Part B Operations

Rejected claim monitoring, medication therapy management, Part B step therapy implementation, Coverage Determinations, Appeals, and Grievances (CDAG) support, transitions of care implementation, formulary strategy, Over-the-Counter benefit design.

Clinical Operations

Case management assistance, SNP Model of Care development and review, chronic disease program design and management, NCQA accreditation assistance.

Auditing

Automated universe analyses, mock CMS program audits, mock informal CMS regional office audits, regulatory audit support, independent audit validation, outsourced routine auditing.

Data and Analytics

Implementation of cross-functional data collection, identification of critical performance metrics for executive reporting, ongoing expert review of plan analytics, HPMS reporting submission analyses, process review or implementation.

Plan Implementation

New plan or service area implementation, including vendor and delegate selection.

Executive Project Leadership

Expert guidance of sweeping operational changes or system implementations to drive successful outcomes.

Software Support

Evaluation of external software solutions and RFP assistance; new software implementation support, including technical requirements, configurations and system reporting; analysis and recommendations for optimization of existing systems; and development of requirements for internal system development.

Executive Strategy Consulting

Identification of large-scale implications of inter-department decisions, understanding critical points of failure and impacts on future success, and recommendations for strategic shifts to integrate critical interdependent functions.

Vendor Evaluation

RFP guidance and development, capability evaluation, pre-delegation review, implementation support.

Growth Strategy

Sales channel strategy (mix and distribution), current market evaluation, provider-based marketing strategy development, benefit design strategy, expansion market analysis.

Compliance Officer Advisory Services

Up to 10 hours a month of confidential one-on-one, personalized advisory services across all areas of the business with our team of industry experts.