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HEALTHCARE SERVICES

strategic guidance in a changing industry

Leadership | Strategy | Transformation | Innovation

Serving global clients for over 20 years.


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Healthcare Services

With no agenda, other than getting it right.  We provide you with strategic guidance in a changing industry through a team of professionals from actuaries to clinicians, technology specialists to benefit specialists, we offer unparalleled expertise in management consulting.   With purchasers demanding more affordable care, how can you restructure operations to lower costs? And how—and where—can you build out population health capabilities at the same time?  We are committed to give healthcare and system executives the tools and insights needed for success across all business segments.

Compliance

For all issues across the CMS compliance spectrum, it is important to approach the project consistently, accurately, and independently. We are able to do just this. We take a complete approach, working with you to design, create or revamp, and implement the entire quality system.


Although audits are a part of our complete quality system services, we can also work with you on an audit-only basis. Once we understand your needs, we can craft a proposal and statement of work.  From here, we work together to develop a project audit plan, schedule your audit, and train the auditor based on your specific needs. When the audit is completed, you will receive an audit report which will have all findings triaged as minor, major, or critical. All reports are checked by your project manager and by our Principal Advisor for quality control purposes. This plan will be reviewed with you and we will begin working to fix any issues as soon as possible.  


We guide you to ensure compliance with governance related to product development and impacts from CMS compliance - NCQA & Accreditation, Medical Policy Review, PII, PHI & HIPAA), Security and Risk Assessments Oversight (HITRUST, SOC2, SLA, KPI etc.), Risk Revenue Management, and more.

Medical Economics

We help companies be more productive, identify opportunities to improve member experience and reduce administrative costs,  strategic funding burdens and operational costs related to healthcare key issues:

  • Population Management and the  Opioid crisis
  • Medical loss ratio (MLR) - Medicare Advantage and Medicaid differential
  • The importance of addressing social determinants of health with your members/patients
  • Ready or not, understanding the financial impacts of quality-based  reimbursements
  • Changes in physician reimbursements
  • Interoperability in EHR and criticality of physician input
  • NEMT (Non-Emergency Medical Transportation) impact on reducing medical costs and improving member/patient outcomes
  • Importance of HIPAA Compliance
  • Artificial intelligence as an accelerator for revenue cycle management challenges
  • Strategies to meet gaps in HIE (Health Information Exchanges) 
  • SaaS Platforms - EDPS to RAPS Software Innovation - who are your partners

Business Process Management

For health care companies, compliance, accuracy, and accountability are critical. Automated workflow processes provide better internal controls and greatly improved efficiency.  


Reduce risk, increase compliance, improve productivity, encourage efficiency, and gain a competitive advantage by reducing work cycles and overhead.  


Some of the ways workflow automation can help healthcare organizations:

  • Strategies for going Lean in Healthcare
  • Maximize value; eliminate waste
  • Centralize and simplify business operations
  • Manage capital and operational expenditure processes
  • Provide a single portal for all employee requests and self-service
  • Ensure a compliant vendor approval process
  • Streamline incident reporting
  • Handle incident management
  • Reduce new product cycles
  • Improve internal audit controls
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