Managed Care Contract Revenue Optimization

Maximizing high quality care while maintaining fiscal viability.

Successful managed care contracting starts with an acute understanding of your network, provider alignment and variations in cost of care.

We are experts in:

• Health plan and capitated population valuation, due diligence and risk assessments
• MSO assessments, enhancements and development
• ACO/IPA design, application, governance, implementation and launch

 

Our Approach

Our team works closely with clients to analyze their data on managed care relationships and positioning, financial and operational performance. To drill down and uncover both acute and actionable insights, COPE Health Solutions collaborates with client teams to conduct one or some combination of the following:

• Current medical spend and utilization patterns to identify opportunities to enhance future performance
• Managed care contract and Division of Financial Responsibility (DOFR) experience assessment
• Assessment of payor contracts for opportunities to improve performance against existing contracts
• Pro forma model development with adjustable variables to help clients understand costs and opportunities