Commercial & Government Health Plans

Our health plan clients range in size and composition from large national, regional, and statewide plans to provider-sponsored health plans and smaller niche plans. These clients rely on us as a trusted advisor and execution partner across a broad spectrum of strategic and operational initiatives within multiple markets.

From strategy development and execution to provider alignment and network transformation to business performance improvement and cost reduction, our engagement teams support plans’ most critical initiatives within their Commercial, Individual, Small Group, and Government Markets lines of business, focused on:

  • Value-Based Transformation
  • Medicare Advantage & Government Markets
  • Risk Analytics
  • Growth & Performance Improvement

Our teams have extensive experience designing and driving tailored care management and value-based strategies that help transform legacy business models and improve performance in a market environment moving quickly toward value-based care. We provide valuable support in: 

  • Organizational & Care Model Design across markets, products, and the internal resource and change management considerations necessary for success
  • Performance Transformation, including care management strategy and vendor selection processes through implementation; capability assessments to enable performance improvement; and new market evaluation, business planning, and launch
  • Value-Based Care Enablement inclusive of the payer/provider clinical program design and implementation; clinical integration models; partnership and contract development, analytics, and benchmarking; and the quality and performance monitoring necessary to achieve shared savings

HealthScape recognizes that the Senior Market, Medicare Advantage in particular, represents a significant growth opportunity for many of our clients. Our teams work closely with health plan clients to capture that opportunity, evaluating the full spectrum of opportunities for entry, growth, and performance improvement.

  • Achieve Senior Market Growth through MA market entry, front office optimization, Medicare portfolio management, and Senior Market migration strategies
  • Improve Performance, leveraging risk economics, premium integrity, revenue improvement, and payment integrity data analytics solutions, as well as focused operational efficiency or Stars improvement initiatives
  • Transform Senior Market Portfolios by re-evaluating short and long-term strategy, organizational alignment, or opportunities for risk migration

We are also recognized experts in helping our clients procure valuable government contracts, and in supporting the performance, compliance, and transition phases throughout contract life cycles. From initial opportunity evaluation and partnership selection through bid and proposal development, as well as implementation support, our teams have supported client efforts in the Medicare, Medicaid, TRICARE, Veterans Affairs, Health and Human Services, and other State or Federal programs. 

  • Medicaid Opportunity Assessment & Partnership Development
  • Dual Eligible Market Entry
  • Bid & Proposal Development
  • End-to-End Government Program Support

Our risk analytics solutions combine industry expertise, advanced data science, and a cutting-edge technology platform to help clients improve the financial accuracy of risk-adjusted and risk-bearing books of business. Through Pareto Intelligence, we offer one-time and ongoing support with:

  • Risk adjustment documentation improvement and compliance
  • End-to-end data quality evaluation and monitoring
  • Medicare Advantage premium accuracy and recoupment
  • Medicare Secondary Payer (MSP) payment issues and monitoring
  • MSP data collection & reporting
  • Financial compliance assessments and remediation
  • Program design and operational best practice evaluation, implementation, and execution

Our broad market experience and exposure enables us to help our clients develop and execute on short and long-term strategic growth and performance improvement strategies. We help clients grow, enhance revenue, contain costs, and improve their top and bottom lines. We act as valuable extensions of our clients’ internal resources to help design and execute upon critical business objectives as they arise. HealthScape can help with:

  • Business plan development
  • Diversification strategies, such as ancillary (dental, vision, life, disability, and workforce) or wellness offerings
  • Turnaround and growth planning
  • Competency and capability assessment
  • Partner/vendor identification, assessment, and implementation
Value-Based Transformation
Medicare Advantage & Government Market Opportunity Capture
Risk Analytics
Growth & Performance Improvement