© 2018-2019 Cliff Frank, Healthcare Management Solutions, Inc.

PROJECTS / CLIENTS

Projects and clients highlighted here are but a small sampling of some of our more recents works. 

 

Additional project and client information can be made available upon request.

Vermont Managed Care - Burlington, VT

Clinical and Financial Integration:
  • Accomplished turnaround and operated a 2,000-provider capitated network for 40,000 commercial lives

  • Contracted with payer partners on a percent of premium or global capitation basis

  • Operated a self-insured employer benefit plan and network at-risk for cost/quality/ patient satisfaction outcomes

  • Managed natural tensions between academic medical center and community providers of care

  • Developed clinical standards of care for review, analysis and intervention by Medical Director or PCPs

  • Managed care for high risk patients across the continuum of care using a patient advocacy model

Shared Savings Model

  • Vermont Managed Care Network comprising primary care physicians, specialty physicians, other providers and hospitals

  • Providers agree to a 15% withhold

  • Necessary to qualify as 'risk-based organization'

  • Withhold is retained by VMC and distributed to network providers based on the financial performance of each plan

  • If total plan costs vary from medical expense target by more than 15% +/-, the payers/plan sponsors either receive a rebate or fund additional dollars

Target PMPM & Distribution Withhold

Shore Medical Center - Somers Point, NJ

  • Built and operated ACO for Medicaid, Commercial and Medicare beneficiaries

  • 35,000 lives

  • $4 million+ in provider bonuses

  • Measured, monitored, reported and affected appropriate utilization, quality metrics, and HCC risk scores

  • Developed risk model for Track C MSSP for 1/1/2020

Connecticut Childrens’ Medical Center - Hartford, CT
  • Renegotiated major contracts for medical center and faculty practice

  • Negotiated bundled payments for Crohn’s and ulcerative colitis including infusion medications

  • Conducted strategic pricing review with consumers shopping for commodity type clinical services

Borland Groover Clinic - Jacksonville, FL

  • Restarted payer negotiations with Blue Cross

  • Designed bundled payment for Crohn’s and ulcerative colitis including infusion medications

  • Designed bundled payment for screening colonoscopy

  • Conducted organizational assessment and leadership initiatives

Palos Medical Center - Chicago, IL

  • Renegotiated major contracts with Blue Cross and others

  • Designed and build a commercial CIN – Chicago Health Colleagues

  • Secured 1st contract with Blue Cross

Centivo - NY
  • Built new model of provider network for large self-insured employers

  • Designed PCP-centric care model to provide close patient relationships and prudent use of hospital-based outpatient services