Strategy and Operations.

The U.S. healthcare industry continues to face numerous environmental and market pressures, and HealthScape Advisors understands the difficult challenges that face health plans today and tomorrow. HealthScape Advisors works with health plans to develop and refine their business based upon a rigorous assessment of their organization, the available resources and the strategic direction of the company. Our technical skills and understanding of market trends and drivers enable us to identify the potential value and capture that value for our clients. We tap our experts' depth of experience and expertise in the industry to deliver significant impact to our clients.

Services

We advise clients on business transformation, capability development, business process improvement, revenue enhancement, market and competitive assessment, and medical cost containment and recoveries.

  • Healthcare Affordability - Design and implementation of total cost management strategies including delivery system and reimbursement redesign; population health management strategies and administrative cost simplification
  • Commercial Strategic Pricing Programs – Client retention durational analysis, new business pricing analysis, and multi product pricing programs
  • New Market Analysis – Market attractiveness, competitive assessments, market segmentation, and diversification strategies
  • Operational Cost Management – Business process improvement, outsourcing evaluation and implementation, cost reduction programs, shared services, and cost efficiency analysis
  • Ancillary Product Strategy – Medical integration including strategic pricing program development, private label implementation, strategic partner evaluation, and whole case underwriting
  • Claim Analytics and Medical Cost Containment - Identification of the key drivers responsible for overpayment, the impact on medical cost, and potential remedies to improve our clients’ bottom line
  • ICD-10 Transition – Impact assessment, competitive advantage identification, feasibility assessments, business requirements definition, implementation planning and project management

HealthScape Advisors Difference

  • Proprietary frameworks, tools and methodologies to support our clients from ideation to implementation
  • Collaborative and practical approach to develop a customized solution for long-term sustainability
  • Exceptional analytical skills, objective and fact-based thinking, sophisticated and rigorous analytics and innovative problem solving abilities
  • Strong financial acumen and excellent understanding of health plan business operations

Representative Experience

  • Performed evaluations of medical management effectiveness including overall program assessments, specific program business case preparation, and administrative and medical cost reduction reviews
  • Implemented comprehensive “whole case underwriting” for ancillary/medical renewals
  • Performed comprehensive book of business analytics to assess ancillary packaging impact to medical persistency
  • Analyzed claim payments related to Medicare coordination of benefits to identify overpayments to providers and increase cost avoidance
  • Performed engagements to assess overall trend and claims payment issues, by service category, associated with major system implementations to identify and correct provider load issues, benefit structure load issues, and edit/audit/workflow deficiencies
  • Performed enterprise wide ICD-10 impact assessment and developed implementation roadmap