The vision
A mission-driven health plan has expanded access for its high-risk Medicaid member population and supported local providers for 30 years. Amid rising cost pressures and increased capital needs, leaders faced a defining moment: stabilize the organization, improve financial resilience, and build an enterprise affordability function to sustain high-quality care for their most vulnerable populations.
Co-creating the solution
The health plan partnered with HealthScape Advisors, a Chartis Company, to confront these urgent financial and regulatory pressures. Together, the team established an affordability framework to focus efforts and embed analytics to enable faster, data-driven decisions. They also created a cost-of-care committee that improved accountability and transparency with senior leaders and the board. The work spanned payment integrity, medical management, network, and revenue improvement, emphasizing rapid prioritization and near-term financial gains while building sustainable capabilities that strengthened the organization for the future.
Believe in better
Within a year, the health plan achieved positive financial performance. The team improved tracking capabilities to manage trends proactively, reducing silos and creating a clear enterprise view of financial implications for decision-making. Leaders’ planning confidence increased, bolstered by a regular operating cadence. With affordability embedded as an enterprise practice, the health plan is positioned to continue to grow and deliver on its mission.
