All successful health plans have an effective and cost-efficient operating platform.  Predictable and sustained success cannot be achieved without it.  We evaluate operational performance, identify costly gaps and implement solutions.  Our unique approach goes well beyond the existence of the right "people, processes and systems" and focuses on your data and real outputs.  We compare your operation to industry best practices and peer performance.

Through claims auditing, contractual compliance, fee pricing and much more, payment integrity has become one of the most widely recognized processes to cut costs for HCOs. We focus on a pre-payment, preventative approach to payment integrity in an effort to withhold payment for inaccurate and abusive claims, as well as mitigate future risk.

Profitability and capital requirements are at the core of health plan performance.  We have extensive experience in financial performance drivers including product design and pricing, provider reimbursement strategies, financial management of operations, claims cost savings (including reimbursement policies) and utilization management.  We'll also be able to guide in the areas of budgeting, forecasting and financial reporting if required.

Not sure if your network and broader delivery system is delivering results - or is well positioned for the future?  We have extensive experience in the design, implementation and management of health delivery systems.  We combine knowledge of todays leading edge strategies with decades of hands-on experience building provider systems to meet population needs.

Developing and managing reimbursement and payment policies is a key component of controlling health spend.  Are you actively managing this aspect of your business?  How do your policies address new therapies, procedures and drugs?  Are your organizations policies aligned with common industry practices?  Are you receiving unnecessarily high member or provider complaint volumes?  We can maximize your performance in this area.

For companies of all kinds, large or small, for profit or non profit, commercial or government programs - we have extensive experience all the way through CEO and board of director positions.  Our primary focus is to provide interim leadership services for vice president level positions and above.

Does your business provide a service or product to health plans?  We continue to see good programs fail due low or nonexistent adoption rates, often caused by improper connecting points to daily operations.  We know the approach to integrate your product into the health plan and/or provider ecosystem. 

Need additional resources or senior - focus to complete an important or complicated project?  We're the team you can count on to deliver on time and budget - and without the ordinary lead time or training required by other firms.