Health Plans

The resources to stay ahead of the game.

Constant change and increasing competition make it tough to stay on top in today’s managed care environment. With ever-changing patient demographics and compliance requirements, there’s little time to focus on innovation. That’s why health plans turn to us for new answers and ground-breaking ideas.

Our team of health plan consultants comes from top level positions at public and private health plans, from the Centers for Medicare and Medicaid Services and from senior advisory positions in government. Together, we offer the experience and connections you need to maintain a competitive edge. Resources for health plans include:

Healthcare Tranformation Institute—helping health plans create new models that incentivize their provider networks to transform member care through delivery system and payment reform. Learn more about our Healthcare Transformation Institute.

Managed care services—cultivating new partnerships between health systems and health plans, improving operations, adding value and supporting quality across the system, including new value-based payment systems. Learn more about managed care services.

Business development—helping plans grow through strategic planning and business development activities, procurement support from strategy to writing and submission, model of care development, mergers and acquisitions and other due diligence, readiness reviews and implementation support.

Compliance—ensuring compliance with current and future state and federal regulations, including audit support pre- and post-audit, policy and procedure development and implementation and compliance program development and implementation.

Integration and Behavioral health services—integrating behavioral health into existing plan administrative functions and into the delivery system, building on existing care management strategies to more effectively engage enrollees with serious mental illness, training and educating the system on integration of physical and behavioral health and developing strategies to grow and improve behavioral health provider networks to improve outcomes.

Clinical services—providing on-the-ground insight into the delivery of care and clinical best practices and programs from former health system executives, practice nurse leaders, clinicians and others. Learn more about clinical services.

Correctional health services—integrating behavioral and physical healthcare, analyzing reimbursement arrangements, evaluating efficiency and effectiveness and reviewing contract compliance and quality improvement. Learn more about correctional health services.

Long-term services and supports—building new models of “whole person” service integration across physical, behavioral, LTSS and crucial social supports like housing and employment and supporting effective person-centered and consumer-directed delivery of LTSS, effective stakeholder engagement, staff and provider training and optimizing delivery and reimbursement for dual-eligible populations. Learn more about long-term services and supports.

HMA Community Strategies—creating connections between health plans and community organizations and finding new ways to keep members healthy and set your plan apart. Learn more about our HMA Community Strategies.

HMA Information Services— providing the ultimate reference for Medicaid information with the most comprehensive data available, all in one location. Learn more about our HMA Information Services.

Data analytics—collecting raw data and turning it into interactive dashboards and other decision support tools, analyzing and presenting multi-dimensional data and evaluating the design and effectiveness of proposed or existing data management systems. Learn more about data analytics.

Healthcare IT advisory services—creating new approaches to improve communication between providers; providing IT gap assessment including organizational initiatives, IT planning and budgeting and IT procurement support; providing IT implementation support including project management and independent verification and validation; re-engineering business processes; and reviewing information systems for compliance with HIPAA and other federal laws and regulations. Learn more about healthcare IT advisory services.

Investment services—providing federal, state and local budget and policy research; regulatory and reimbursement trend analysis; delivery system assessments; competitive market evaluations; outreach to stakeholders; review of provider contracts; and other customized support. Learn more about investment services.