Managed Care: From policy and regulation to innovation, implementation and operation.
More than 30 years after it became part of the healthcare landscape, managed care is still a key growth area in the health insurance market. And continued growth means continued change, with new member demographics, new regulations and constant pressure to meet new operational goals.
Our team of managed care experts has unique experience on both the policy and operational sides of the managed care spectrum. We can help with both high-level strategy and the nuts and bolts that make new programs successful on the ground. Many of our HMA team members come directly from careers as state and federal officials and from public and private managed care plans serving a wide variety of populations. Their areas of expertise include:
- Supporting procurement including strategy development, win-themes, draft development, mock scoring and production
- Performing due diligence, mock audits, gap analysis and readiness reviews in preparation for mergers and acquisitions, regulatory or accreditation audits and expansion into new markets and programs
- Implementing change including staffing structures and job descriptions, developing and implementing policies and procedures, producing and delivering training curriculum and materials, creating workflows and job aids and managing projects
- Implementing new programs and enhancements such as quality improvement plans, compliance plans and utilization management programs
- Developing and implementing policy
- Interim staffing and subsequent onboarding/training for start-up operations, new markets, temporary fills and hard-to-find replacement positions
- Building strategies and models of care for complex care populations with chronic conditions and co-morbidities
- Developing and managing provider networks
- Analyzing payment and reimbursement strategies
- Identifying and pursuing emerging business opportunities
- Programs for All-Inclusive Care for the Elderly (PACE) and managed LTSS technical assistance