Business performance improvement

We help clients enhance revenue, contain costs and improve their bottom line.

Overhead and Administrative Cost Management

Competency and Capability Assessment

Turnaround and Growth Planning

Medical Cost Reduction

Claim Accuracy and Overpayment Detection

Product Line Profitability Analysis

Government Market Performance Improvement

  • Performed an adminstrative cost review of all major functions supporting a health plan's specific line of business, which included developing Service Level Agreements with multi-year adminstrative cost targets for each major function
  • Evaluated a health plan's current Star Ratings and identified a focused set of actions that would have the greatest impact on performance, followed by a tactical remediation plan to implement improvement opportunities
  • Evaluated medical management effectiveness including overall program assessments, specific program business case preparation, and administrative and medical cost reduction reviews to develop a customized solution for long-term sustainability
  • Identified millions of dollars in Medicare overpayments for various clients through our extensive coordination of benefits process
  • Assisted a Pharmacy Services Organization develop financial reporting capabilities needed to continue to manage business on an efficient basis

Client Need

Client requested HealthScape’s assistance with identifying operational improvement opportunities that would drive improved financial performance in a specific line of business.

HealthScape Approach

  • Conducted one-on-one interviews with Executive Leadership to understand operational strengths and weaknesses, competitive landscape, and the rate-setting process
  • Performed a thorough review of cost of care and provider contracting to identify root causes of poor financial performance:
    1) Reimbursement and utilization trend analyses of high-dollar service categories
    2) Provider coding and risk-capture assessment
    3) Coordination of benefits evaluation
  • Projected short- and long-term financial impact of successful implementation of identified opportunities

Outcomes

  • Identified numerous operational improvements that will significantly improve revenue and lower cost of care
  • Developed a sophisticated risk-capture tool that allows the client to identify provider targets that can benefit from tailored strategies and tactics to improve coding
  • Identified aged and disabled members with claims that should have been paid by Medicare

Market Momentum in Oncology Management

In this article, we provide a look into the proactive approaches plans are taking to tackle growing cost concerns while promoting coordinated, high-quality care.

Service descriptions
Representative experience
Case study
Insights