The convergence of market forces is driving value-based transformation in nearly every area of health plan organizations.
Change seems to be the new constant in healthcare today. The industry’s growing regulatory and market pressures present health plan leaders with a barrage of business challenges. And while this list of necessary changes grows, so do the expectations for a decisive response to the new market.
Health plan leaders are tasked with bringing their organizations through an era of unprecedented transformation - operational change to respond to the Affordable Care Act and introduction of retail markets; defining new financial risk sharing models to “bend the cost curve” while supporting quality of care improvements; responding to shifting customer expectations in transparency and access to care; and the need for a more agile workforce.
Our team of specialists is well equipped to work closely with your organization to understand the unique impacts of the changing market on your organization. We can work with you to plan and execute strategic projects to help your organization respond to these market pressures. We draw from a wide variety of successful projects covering many functional areas of a Health Plan to develop unique solutions to help your organization respond to these market pressures. Our service offerings tailored to the Health Plan industry include:
- Value-based care program strategies – developing strategies backed by analytics to help you define the right reimbursement model for each of your providers and guidance for the construction of provider networks and products that meet your unique marketplace needs.
- Operational Transformation – enabling change to core business processes, systems, and organizational responsibilities, whether driven by new innovative financial reimbursement approaches in your provider networks, the introduction of new products and networks, or through the adoption of new business models. Helping as you migrate across the continuum from fee-for-service to fee-for-value.
- Member Experience – defining purposeful interactions with your prospects across their lifecycle of interactions with your organization to differentiate your products in the marketplace via the member’s experience.
- Talent Management – managing one of your most critical assets, human capital, through talent acquisition, performance management, learning and development and succession planning, to drive employee behaviors that lead to accomplishment of business results.
- Risk Optimization – building a sustainable and constantly improving risk adjustment and quality management program to address your critical risk adjustment challenges and take end-to-end control of your risk adjustment processes.