What We Do
Our Analytics-Driven Approach Delivers Real-World Results.
RECENT PROJECTS
Payment Integrity
Healthcare payers process billions of dollars in claims, demanding tight control on fraud, waste, abuse, errors, subrogation, and coordination of benefits. With so much money in motion, overpaying or paying for wrongly authorized claims can be seen as a cost of doing business.
WSG has delivered significant medical cost savings to several clients from regional to national payers. We have designed and built payment integrity organizations from the ground up, including developing staffing and capacity models, job descriptions, financial and operational metrics, business processes and procedures, and analytics to identify sources of medical cost leakage.
Payer Services Data Management
An industry-leading population health management company sought value-based solutions to improve the clinical care and financial performance of high-risk, high-cost kidney patient populations.
Well Solutions Group provided a Senior Business Analyst to support key initiatives around:
- Data Warehouse
- Data Governance
- ADT data Implementation
Pharmacy Solution Methodology and Delivery
A leading PBM solution provider needed support in transitioning to a new healthcare platform used by patients within a health plan.
Well Solutions Group worked with the delivery team to support the transition of services and knowledge from the legacy system to the new platform.
The new system helps patients navigate their prescription drug coverage, make informed decisions about their medications, and reduce medical spend for non-compliance.
Provider Services Data Management Strategy
A home-based care client needed support in strengthening their data management, analytics and business intelligence capabilities.
Well Solutions Group provided a Business Architect to establish standards, best practices and recommendations around healthcare data management, analytics, and calculations.
UM Data Management and Analytic Enablement
WSG helped an organization use its existing data to improve performance, make better decisions, and optimize processes. This data management initiative included:
- Uplift sourcing of clinical program application data to a Cloud database providing large
performance and stability improvement and retirement of on-premises database. - Design and development of an analytic solution to support UM program efficacy
evaluation.
Enrollment, Billing, and Reconciliation
Enrollment, billing, and reconciliation compares enrollment data with billing data to identify and correct discrepancies. After a payor client failed a Medicare audit and was placed on a corrective action plan by CMS, WSG was brought in to ensure that healthcare providers receive the correct amount for their services and that there is trust between healthcare providers and insurance companies.
This initiative included putting new processes in place, reconciling member files, and speeding up reporting metrics. We focused on all lines of business — Medicare, Commercial, ASO, and Medicaid. CMS standards were met, and the corrective action plan was removed.
Claims Appeal Process
Claims appeals must be handled in a timely, coordinated fashion with different requirements for each line of business. WSG reengineered the appeal process from the ground up that eliminated bottlenecks, established a centralized team, integrated tracking to measure productivity and performance that not only allowed business rule variation, but also ensured early warnings for potential regulation requirement risks.
NCQA Compliance
Healthcare organization quality and performance are accredited by NCQA — the leader in healthcare accreditation. After failing an audit in several areas, a payer contacted WSG to manage a corrective action plan.
Within a few short months, WSG not only identified the root causes of non-compliance but also remedied the Corrective Action Plan while simultaneously equipping the ongoing team with the tools, knowledge, and techniques to achieve ongoing accreditation.
Payer Transparency in Cost
WSG understands the Transparency in Coverage Mandate and has worked with clients and vendors to achieve compliance.
We helped a client navigate the complexities of obtaining, organizing, and synthesizing provider, clinical, and cost data to align with the mandate’s requirements. We positioned Transparency in Coverage to become a competitive advantage and bring value to members and stakeholders.
Healthcare Playbooks™
We fast-track seamless implementation of your strategic initiatives.
Each year, management consultants charge billions to research a problem and make recommendations. Our playbooks fast-track the opportunity, develop a roadmap, and get you up and running before traditional consulting gets off the ground.
Well Solutions Group works like a clinician. Our industry experts have built a body of knowledge over the course of their careers. From a solid starting point, our work is tested and documented to help solve new problems for new clients.
We call these templates Healthcare Playbooks™ because most management issues can be solved with proven approaches. Our plug-and-play process allows us to ramp up quickly and address your specific needs while aligned with your corporate culture.
Our Playbooks get you there faster:
Product Development Playbook
The Product Development Playbook includes temperature checks, clear success metrics, and a best estimate for Minimally Viable Product (MVP).
We move your project through product stages in sprints to maximize efficient governance and delivery.
Business Model Evolution
New technologies, regulations, pharmaceuticals, and CMS programs keep our industry in flux. The challenge is to find the fastest and most efficient path to leverage these opportunities.
Our Business Model playbook combines market insight, capability assessments, partnership opportunities, and targeted triggers and roadmaps to maximize your return on investment.
Cross Functional Optimization
The key to delivering value cost-effectively is to develop processes, metrics, and shared goals across the claim lifecycle.
Our playbook approach optimizes the claims process and flow of data from enrollment to reconciliation. We help you optimize the entire claim ecosystem including the involvement of your partners and vendors.
Data & Analytic Enablement
Our Data Management Playbooks provide a clear path to assess, prioritize, and build data models while providing analytic transparency.
We bring the talent and leadership who can prepare, model, and validate your required data insights. From job descriptions to model development, our Playbooks simplify and empower your organization’s data infrastructure.
Payment Integrity Playbook
Identifying missed cost savings opportunities requires a top-to-bottom review of the entire claims payment ecosystem.
Our Payment Integrity Playbook includes not only claim adjudication and payment, but also network, member benefits, clinical services, vendor strategy, and claim payment continuum. From current state heatmaps to, opportunity prioritization, Well Solutions Group is a leader in optimizing payment integrity.
Organizational Design and Reengineering
Major transitions such as market expansion, new lines of business, and leadership turnover consume inordinate department resources.
Our Reengineering Playbook develops baseline processes, identifies success measures from structured templates, designs organizational flows, builds job descriptions, and establishes hiring triggers. Our Transition Management Playbook can develop 90-day, 180-day, and 1-year impact strategies.
CMS Compliance Playbook
CMS rule changes around prior authorizations, response times, denial rationales, public disclosure of metrics, and data accessibility can impact your star ratings.
Our playbook breaks down major active and upcoming CMS requirements for health plans and provides the baseline to customize processes and procedures to meet CMS requirements.
Selling to Health Plans
Health plans identify value, decision-making, and timing in ways that, if not understood, may delay or block your sale.
Our Selling to Health Playbook ensures that your due diligence, product concept, business case, and security assessments will pass scrutiny. We help identify the essential players, messaging, and timing necessary to expedite your sale.
Flexible Engagement Models
WSG Playbooks accelerate your strategic initiatives.
Consulting Model
Our consulting model follows a structured approach with key phases including understanding your needs, data collection and analysis, diagnosis of the problem, solution development, implementation planning, execution, monitoring, and evaluation.
We bring a client-centric focus and use our Healthcare Playbooks to analyze information and develop and implement solutions. Importantly, we prioritize your needs and objectives throughout the consulting process.
Fractional Model
Well Solutions Group can provide industry experts part-time for a set number of hours per month or on a retainer basis.
It’s a good option for many businesses because it’s more flexible and cost-effective than hiring a full-time employee. Here are some benefits of fractional consulting. It makes it easy to hire specialized expertise to adapt to market demands or special needs.
Managed Services Model
While Managed Services typically apply to IT infrastructure, companies can outsource consulting services to continuously reduce costs, improve performance, focus on core competencies, and gain access to the talent they might otherwise lack.
Our managed services model is a good fit for any size business that wants continuous support and access to specialized knowledge from the entire Wells Solutions Group team.
Private Equity Advisory
Well Solutions Group offers a proven strategic approach to assessing business opportunities including:
- Acquisitions
- New Products and Services
- Divesting Strategies
- Strategic Growth Plans
- Leadership Road Maps
We support your business decisions by identifying growth opportunities and determining the strategic path to achieve your goals.
