Healthcare Management Solutions, Inc. offers a wide range of services including our newest service - Healthcare Management Solutions Turnaround Team:

​

Our Team includes physicians, stategists, operators, finance experts, actuaries, and economists.  We work together through these tough, demanding turnarounds to get to a high performing, focused organization that is producing the necessary results.  Healthcare Management Solutions' particular focus is on heathcare organizations that have taken on managed care risk or are seeking to take on risk - health plans, ACOs, Clinically Integrated Networks, Medical Groups, and health systems that are engaged in risk assumption through those types of entities. 

 

We offer creative, results-driven, back-end arrangements where the majority of the fees are paid as results are delivered through execution on operational improvements.  Our team is focused on value-based organizations and our turnaround work is structured on the same basis - payment for value.

​

So, who's on the HMS Turnaround Team? 

 

 

 

 

Other Services Include:

 

 

--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

 

--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.

 

--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

 

--Direct Contracting with employers

 

• professional and/or facility arrangements with employers to enhance or replace existing payer networks.

 

--Direct Primary Care arrangements with employers

 

• high performance PCPs plus care support to drive high performance clinical and financial results.

 

--New product, service, device advocacy to payers

 

--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.

​

​