Insights Through Experience
Giving providers and provider organizations the actionable insights to manage cost and quality of care.
Through decades of hands-on operational experience, we identify best practices to achieve optimal performance when considering the combination of healthcare delivery costs and quality.
Managing the full continuum of total cost of care includes everything from coding / compliance and data / analytics to medical management and clinical quality.
We center our focus around provider initiatives and performance, an area where we have deep expertise and experience.
Experience with Provider Performance
Reporting & Analytics
-
Developed KPI and standardized reporting for utilization & cost of care performance.
-
Designed risk stratification methodology to identify and manage population health initiatives.
Network Design / Contracting
-
Designed baseline terms, incentives and expectations of provider network payer contracts.
-
Selection and evaluation of high-performing specialist networks.
-
Contracted networks of PCPs and Specialists in partial to full risk arrangements.
Network Operations
-
P&L ownership / operations of multiple full-risk provider entities at profitable Medical Loss Ratios; Medicare Advantage, Medicare and Commercial populations.
-
Formalized routine provider interactions, distribution of materials and education for providers and management personnel.
Quality & Outcomes
-
Creation and management oversight of pay-for-quality programs.
-
Led CMS STARS initiatives at national payer organization.
