Healthcare Management Solutions, Inc. offers a wide range of services including:
1. Provider network development and management:
build or manage ACO networks among providers around hospital, or among themselves.
- governance, ACO participation agreements, bonus distribution formulas, physician
recruiting to join the ACO
Payer contract negotiation for shared savings or provider risk transfer including:
-Attribution method, quality metrics definition and measurement, spending targets,
risk adjustment, performance measurement, shared savings percentage, high cost outlier
carve-outs, division of financial responsibility (DOFR) inside provider risk transfer agreements.
build or manage administrative infrastructure to support shared savings or risk contracts including:
-data systems for enrollment or attribution reporting, claims reporting, utilization analysis,
referral reporting and monitoring, clinical variation analysis, budget to actual reporting, and
bonus distribution methodology
2. Turnaround troubled provider networks, provider-owned health plans, and managed care departments
Assess, Lead, Act, Report, Manage provider networks that are in trouble - financially, organizationally, functionally, or poorly positioned in the market.
Redesign contractual arrangements with payers, restructure provider participation, and redirect care management processes toward higher-value activities.
3. Managed care assessment and payer contracting support:
Contract rates compared to market, contract language, contract administration, denial management, revenue realization, managed care committee, utilization review friction, plan steerage toward or away from provider, benefit designs, narrow networks, managed care strategy to increase economic value of payer relationships
4. Direct Contracting with employers
professional and/or facility arrangements with employers to enhance or replace existing payer networks.
5. Direct Primary Care arrangements with employers
high performance PCPs plus care support to drive high performance clinical and financial results.
6. New product, service, device advocacy to payers
7. Recruitment of managed care payers to providers for special partnerships to manage target populations, products, or relationships such as private label Medicare Advantage plans, narrow networks, MEWAs, Association Health Plans, and other niche products.