Our approach to building engagement teams with associates enables us to deliver top quality results for any size project. The following is a select list of recent engagements.
Health Insurers/Managed Care Organizations
- Conducted medical management (utilization management, case management, disease management) performance evaluation against external benchmarks
- Developed integrated medical management strategy (case management, disease management, and wellness and health promotion)
- Conducted performance benchmark and leading practice survey for utilization management, case management, and durable medical equipment (DME) cost management
- Developed and presented strategic options for profitable growth to the board of directors for a $100 million national PPO network provider – Aligned $300M in investments with strategic direction
- Led 30 executives in development of and agreement on 3-year plan for performance improvement in 5 key areas: claims, utilization management, provider service, member service, enrollment
- Conducted project management evaluation to determine likelihood of success for a project – led to redefinition of role of project manager
- Facilitated 40 business and technical participants in the development of a conceptual model and draft specifications for a medical cost forecasting model*
- Led team of 80 people from different parts of organization to develop an integrated condition analysis approach*
- Streamlined and integrated medical management, PBM and disease management approaches for medication management into a comprehensive pharmacy management program*
- Conducted feasibility analysis for a payer in response to the the CMS Medicare Modernization Act, Part D – Identified core competencies, market considerations, revenue potential, investment requirements for becoming a standalone Prescription Drug Plan (PDP)
- Created request for proposal and evaluation tool to support medical management vendor selection
- Conducted system selection for claims, automated document generation and product configurator systems
- Standardized and streamlined business operations for a $20 billion national health insurer through process redesign, system modification and organizational restructuring – Increased effectiveness and efficiency and improved customer service capability.
- Achieved performance improvement from system implementation through process redesign, business specification/system modification and organizational restructuring for multiple applications, including claims, medical management, sales, customer reporting.
- Developed several multi-product, multi-state, implementation plans designed to accelerate realization of benefits and minimize disruption to operations while implementing new processes, procedures, systems, and organizational structures
- Conducted research and identified 'Promising Practices' for ACO population health management.
- Performed a population health management/care management assessment for an integrated health system to determine capabilities and readiness to manage a Pioneer ACO population.
- Guided the development of pay for performance measures sets for 3 national specialty physician organizations in response to the CMS Physician’s Quality Reporting Initiative/System (PQRI/PQRS) program
- Designed and developed web-based Practice Improvement learning tool for two specialty physician associations to support American Board of Internal Medicine Maintenance of Certification requirements
- Supported change management for Oracle/PeopleSoft implementation for a state university and medical school
- Serving on the Care Continuum Alliances’ Integrated Program Evaluation Work Group, part of the CCA’s 2012 Quality and Research effort to develop guidelines for the evaluation of integrated population health management program for ACOs and PCMHs.
- Facilitated the development of a multi-stakeholder governance entity to provide oversight to key clinical, technical, financial and legal (privacy) aspects of a statewide Health Information Exchange (HIE)
- Coordinated development of the Strategic and Operational Plans for expansion of statewide Health Information Exchange (HIE) in response to ONC cooperative funding agreement using a series of highly integrated stakeholder work groups
- Converted laboratory results from 3 different practices into standardized LOINC codes to enable clinical outcomes reporting – Enabled the use of 20 pre-selected outcomes measures to evaluate the impact of health information exchange (HIE) and electronic health records (EHR) in three Massachusetts communities
- Conducted research to identify leading practices in obesity treatment
- Developed obesity benefit design including actuarial analysis*
*Denotes engagements accelerated using Large Team Facilitation