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What
Strategies and Solutions can do for
you:
[Strategic
Planning] [Operational
Assessments]
[Benefits Consulting] [Product
Design]
[Program
Assessment / Development] [Financial
/ Risk Assessments] [Competitive
Intelligence]
[Statistical
Studies] [Due
Diligence] [Audit
Services] [Information
Systems]
[Additional Services]
Strategic Planning
Top
-
Facilitate planning
meetings with Boards of Directors and Executive Staff
-
Identify issues and
concerns with current business functions, e.g., goals and objectives,
mission and direction
-
Perform a SWOT
(strengths, weaknesses, opportunities and threats) analysis
-
Explore strategies
that enhance the financial outlook and stability of the organization
-
Consider market
readiness and potential opportunities - locally, regionally and nationally
-
Develop models of
organizational structure based upon capability and desired level of risk
-
Align the organization
to meet the changing demands of the industry
-
Recommend
infrastructure or system changes necessary to maximize efficiencies
-
Facilitate discussions
and negotiations with other organizations and business partners
Operational Assessments
Top
-
Assess operational
procedures and determine areas of strength and weakness
-
Review organizational
documents (e.g., mission statement, business plan, policy and procedure
manuals, organizational charts, job descriptions, and management reports),
staff skill levels and areas of responsibility to modify and/or make
changes to help the operation run more efficiently and effectively
-
Assess reimbursement
and funding mechanisms to identify additional/alternative funding sources
or revenue streams
-
Analyze financial
statements and performance documents in order to highlight financial
concerns or operational areas needing attention
-
Provide
recommendations and strategies that enhance operations at departmental,
divisional and organizational levels
-
Assess infrastructure
capabilities and needs
Benefits
Consulting
Top
-
Analyze health plan
cost and utilization by SIC, employer size and benefit type
-
Highlight trends and
aberrant outcomes
-
Consider initiatives
to enhance treatment patterns and lower cost and utilization
-
Provide cost-benefit
analysis of desired initiatives
-
Assist in the
negotiation and enrollment process
-
Assist with problem
claims between employees and health plans
-
Work with providers,
insurers and employers to provide care in the most meaningful, beneficial
and financially viable way
Product Design
Top
-
Perform competitive
analysis and needs assessment
-
Develop rating
methodology, key assumptions and source data
- Review
existing law and legislative requirements
- Price benefit components and
administrative costs
- Establish provider network volume and
accessibility needs
- File product offering with the required
regulatory agency, e.g., Department of Business Regulation or Division of
Insurance
Program Assessment/Development
Top
-
Analyze existing
programs and respective cost/benefit - Evaluate program design, key
program components and flow of funds structure
-
Perform internal and
external environmental scans
-
Review and analyze
laws, regulations, guidelines, specifications and requirements governing
respective programs
-
Review and assess
outcomes regarding program performance, customer satisfaction, operating
cost, resource allocation, etc.
-
Develop program
enhancements or redesign, and assess the respective feasibility and cost
effectiveness
-
Outline the steps
necessary for successful transition
-
Assist in the RFP
process and vendor evaluation
-
Provide
recommendations and assist with program implementation
Financial / Risk Assessments
Top
-
Assess financial
arrangements, e.g., percentage of premium, global capitation, fixed fee,
risk sharing, hospital per diem, and physician fee schedules
-
Conduct cost/benefit
analyses to assess financial adequacy and reasonableness of proposed
health benefit reimbursement that is reflective of specific health benefit
coverage
-
Consider case-mix,
demographics and selection of intended member populations
-
Evaluate the financial
exposure of designed financial arrangements
-
Provide a break-even
evaluation and a pro-forma analysis
-
Construct alternative
financial arrangements with varying risk corridors and risk sharing bands
to provide desired protection
-
Provide actuarially
sound strategies for negotiating financial arrangements and administrative
processes
-
Establish
infrastructure requirements needed for successful financial and
operational management of negotiated arrangements
Competitive Intelligence
Top
-
Collect and review
financial statements, rate filings, plan performance and certificates of
coverage on a quarterly and year-end basis
-
Track and monitor
cost, utilization and enrollment trends for various populations including
Commercial, Medicare Risk and Medicaid
-
Develop actuarial
values for various health plans, benefit offerings and network designs
delivered within HMO, PPO, POS and indemnity healthcare systems
Statistical Studies
Top
-
Assess demographic
differences such as age, gender and ethnic composition by Metropolitan
Statistical Area, Service Delivery Area, County and State
-
Evaluate market
characteristics by industry - labor force and employment, employer size,
occupation by race and gender, commuting patterns, etc.
-
Profile provider cost
and utilization statistics; perform competitive comparisons among
providers or across specialties
-
Analyze financial
statements, plan performance, cost, utilization and enrollment
Due Diligence
Top
-
Review documents to
assess financial stability
-
Assess operational
viability - administrative capabilities, contracting capabilities, value
added services, cost/benefit analyses, operational efficiency
-
Present findings,
advantages, disadvantages, cost, opportunity cost, and recommendations
Audit Services
Top
-
Review eligibility
files to assess accuracy with effective and termination dates
-
Review claim files to
assess timeliness with the payment process
-
Review payment
accuracy, including copays, deductibles and provider discounts
Information Systems
Top
-
Determine data needs
and define data elements
-
Assess accuracy of
data capturing
-
Design database
tables, queries and reports
-
Design and implement
management information systems
Additional Services
Top
-
Develop Actuarial
Models
-
Review Contract
Language
-
Research and Analysis
-
Perform Statistical
Studies
-
Present
Educational Seminars
-
Perform Customer
Satisfaction Surveys
-
Perform Market
Assessments
-
Establish/Develop
Provider Networks
-
Write/Evaluate RFPs/RFRs
-
Develop
Infrastructures
-
Third
Party Administration
For more information
about what Strategies and Solutions can offer you or to arrange an initial meeting, please call
(401) 295-8046 or e-mail:
info@StrategiesAndSolutions.com. |
