Health Plan Consulting

Strike a balance between innovation and practicality

Industries/ Healthcare & Life Sciences/ Health Plans /Health Plan Consulting

Health plans face challenges in balancing the need to lower the costs while transforming healthcare to be patient-centric and data-driven. While digitization and integrated care demand attention, healthcare executives must resolve many other traditional and next-generation issues every day. We will help you balance the need to innovate with the practical demands of daily operations by providing a set of key services and expert personnel. Our consulting group is experienced in health plan operations as well as the innovative solutions you need for competitiveness and sustained growth for your organization.

Our Health Plan Innovation and Consulting group provides guidance at every step.

We can help

Modernize and optimize core platforms such as claims, billing, and enrollment

Improve your strategic and operational model

Converge towards an integrated care delivery organization

Create information management programs that consolidate member data using advanced integration and big data platforms

Our solutions:

Strategy and Architecture Consulting
Your portfolio of business services and IT applications must constantly align with business objectives and industry mandates. Yet, operational dynamics often require tactical decisions that divert you from this alignment. Our experts provide in-depth analysis of your current operations and a roadmap to keep you on course towards your strategic milestones. We go further than traditional strategists by working as a partner to your organization to develop a strategic roadmap. This keeps us accountable for the strategy we help you create and ensures a better return on your investment.
Core Platforms Recommendations and Planning
As health plans have grown, many have adopted technology to fit a narrow purpose, resulting in a tangle of overlapping IT systems, outdated processes and redundant work. With expertise in many leading core platforms, our experts can help you consolidate core business processing platforms and create an efficient structure that can bring huge savings in licensing, support, and infrastructure. We typically focus on claims, billing, enrollment, and network management, but we are also knowledgeable in the surrounding eco-systems of vendors and applications.
Accountable Care Organizations
As more payers and providers join hands to create ACOs to improve patient health and lower the cost of care, many struggle with planning, monetization and infrastructure needs. Our ACO experts can guide you all the way from the planning stage to operating models. We can help you with the business case for forming an ACO, the application process, performance indicators and a sound monetization model. One of the biggest challenges that organizations of all sizes face is creating infrastructure to operate ACOs. With our mature infrastructure products, combined with ACO-specific architecture & planning, we can help you reduce the cost and complexity of your infrastructure while building a patient-centric health system.
A lack of interoperability has become a crucial issue for most health plans. This includes both connectivity within your own systems as well as business integration with providers and other participating entities. To work effectively with providers to deliver integrated care requires that you use data from healthcare information exchanges, lab and pharmacy systems, social networking, and telehealth and remote monitoring systems. Our integration professionals have experience integrating numerous disparate systems using traditional and advanced interoperability standards and frameworks..
Population Health Management
Improving outcomes for members and lowering the cost of care requires aggregation of member data – clinical, administrative, and social – and channeling it to identify and stratify risk and close care gaps across all care settings. We have extensive expertise in population health and specific support for your endeavors, such as Patient 360 view, analytics for risk stratification, care management systems and a network of partners to deliver better outcomes at a lower cost.
We have a deep background in computing infrastructure and a portfolio of healthcare-specific platforms, applications and infrastructure. Our infrastructure architects can shape your applications, networking, data centers and cloud-based services to better meet your needs, and our engineers can build and support it. Our ability to provide architecture, engineering, and 24x7 support will let you focus on your business.
Staff Augmentation
The important link between business objectives and superior performance is people. Our experts can help you align resources with organizational goals and create a sustaining backbone for growth and innovation. From business architects and strategists to solution creators and development teams, we have a wide range of value-creating professionals to augment your workforce. Our innovative staff augmentation models include virtual CTO/CIO services and an external architecture review board (ARB) service, plus support staff to enhance your day-to-day operations.