In the News
Stories and trends changing the healthcare landscape
Healthcare organizations are increasingly using consumer data to augment their understanding and insights into the populations they serve, for a variety of purposes – from forecasting health outcomes, risks and future use of services to development of strategies for outreach and engagement. Consumer-generated data includes a wealth of information about individuals – including what they purchase, how they use social media, how many hours their wearable devices say they sleep at night, and other aspects of how and where they live and work.
The COVID-19 pandemic has changed the way people interact with each other, turning to video and other forms of social media to stay connected. This embrace of virtual technology has extended to medical care and has paved the way for what may very well result in permanent changes in the how health care is utilized and reimbursed.
We can all agree COVID-19 brought about a seismic shift in the delivery of healthcare in 2020. This article reflects on services shifts, challenges those shifts create and approaches for providers and payers to anticipate and navigate the initiatives.
CMS is planning to reduce mandatory bundles based on results, provider feedback and “minimum” utilization considerations. Some programs will be cancelled, some will not launch in 2018 and one is being scaled back.
At the same time, we are helping our clients achieve great success building population health risk based management solutions. Let us help you identify your opportunities to improve outcomes and reduce the cost of healthcare.
Private Equity Healthcare Consulting
Weigh Growth Opportunities and Achieve Analytical Clarity Before Major Acquisitions
We apply our sector expertise to create opportunities:
Payor and Payor Services
Provide Healthcare boards industry insight on trends, maturity, opportunity and risks around healthcare product and services in the payor industries . They leverage to determine key strategies and growth opportunities.
Provider and Provider Services
- Provide research and documentation on concepts, competition, examples
- Consult and answer questions
- Develop strategies to grow and risk mitigation for Private Equity
- Provide recommendations for leadership benchstrength including candidates and evalution
- Brainstorm and evaluate innovative concepts
- Go to market strategies
- Business Case Development and Evaluation
- Board meeting insights on trends, maturity, opportunity in general as well as specific healthcare products and services
Our multi-sector experience opens doors.
By connecting the dots industry-wide, we tap into emerging trends and leverage synergies across the landscape:
- New Revenue Stream – We developed a product strategy using upgrade packages as a means to generate added revenue.
- Sector Opportunity – For a Specialty Benefits Management client, we identified a new sales channel through a network of physicians.
- Data Opportunity – Using a client claims feed provided for analysis, we identified that this data source could be used to determine fraud and abuse.
- Expanded Services – We expanded the capabilities of a client prior authorization system to identify unlicensed providers, generating quality of services standards and savings.
Susan Quint, Analytics Business Consultant for Well Solutions Group, describes her consultative approach to working with clients.
“Looking for ways to reduce your post acute costs for the Mandatory CMS Joint replacement bundle? New products are entering the market that allow providers to gauge progress without onsite visits…in surprising ways. Microsoft Kinect shifts from gauging your dance moves to measuring your gait and recovery from hip or knee replacement. In addition, tracking and providing on demand rehabilitation therapy programs with instant feedback. Tell us what you think!Read More.
Medicare Advantage Plans, need to update your strategy? Provider responsibilities and look back periods are reduced in the CMS final rule for overpayments. See more information:
The Centers for Medicare & Medicaid Services has issued a final rule regarding the legal requirements providers most follow if they are overpaid.
Medicare uncovers claims overpayments due to incorrect units of service and provider coding errors. CMS states Medicare contractors should collect their overpayments – how many outpatient overpayments are overlooked? Most focus on inpatient only. We can help!See More