Health Plan Build or Optimization
More seniors are choosing Medicare Advantage, Medicaid expansion is active in 40 states, and more health systems are considering how to leverage their own employee health plans to access ASO and other commercial opportunities. This is contributing to a rethinking of the value provider sponsored health plans can bring.
Our team of experts brings deep health plan build, restructuring, optimization and management experience to ensure our clients succeed with their health plan strategy.
We build new health plans, provider owned and independent, optimize performance of and restructure as needed health plans of all types and sizes and bring a strong track record of proven performance.
Our Approach
Gain alignment and understanding of strategic drivers, challenges and opportunities for an existing or planned new health plan, including potential expansions into new geographies and lines of business
Collaboratively develop a set of strategic objectives, including desired future state risk-model framework and consensus on population health management requirements to achieve VBP growth goals over the next three to five years.
Gap assessment to determine build and buy requirements based on strategic goals
Detailed operational plan for implementation, whether new plan or product launch, TPA build/buy, expanded geography and network build, optimization or restructure of entire plan or any functional areas
3-5 year implementation roadmap for TPA and health plan build or optimization
36 to 60 month co-source agreement with detailed division of responsibility framework, operational implementation plan and VBP contracting playbook
Provide a team of experts to co-manage and ensure success
