CONSULTING AND PROCESS OPTIMIZATION
We apply our deep expertise and industry experience to advise health plans and other risk-bearing organizations across multiple dimensions.
- Best practice approaches to clinical operations and care management
- Medical-behavioral integration
- Social Determinants of Health
- Analytics approaches for population health initiatives
- Monitoring
- Auditing and mock audits
- Corrective action plans
- Remediation to manage risk
- Regulatory and compliance submissions
- Delegated Oversight
- Quality improvement initiatives
- HEDIS
- Stars
- State-required measures
- Internal measures
- Performance measurement
- Assessment, planning, oversight
- Leadership and support for initial accreditation and renewals
- NCQA
- URAC
- State requirements
- Readiness assessment, planning, prepareation and submission
- Assessment, gap analysis and recommendations
- Implementation, training, team building, system changes
- UM, CM, MOC, Population Health
- Payment Integrity & Claims Adjudication; Fraud, Waste, Abuse
Engagement examples include:
- NCQA accreditation readiness assessment, planning, preparation, and submission
- Best practices for Behavioral Health Utilization Management and Physician Review
- Quality program assessment, planning, and oversight
- Comprehensive Utilization Management program design and implementation
- Institution of effective claims adjudication and Payment Integrity program
Other consulting services include Clinical Content and Program Development, Educational Training Programs and more. Please contact us for inquiries.
