Healthcare Management
Solutions, Inc.
 

Services:

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Healthcare Management Solutions, Inc. offers a wide range of services including but not limited to:

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--Provider network development and management:

• build and/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.

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--Strategic Growth Consulting

• Business model innovation for healthcare growth and payer alignment

• Multi-site expansion strategies across urgent care, virtual care, and freestanding ER models

 

--Payer Strategy and Value-Based Care Transformation

• Design and negotiation of commercial and Medicare Advantage contracts

• ER diversion models, risk-sharing agreements, and payer-provider integration

 

--Operational Optimization and Enterprise Scaling

• End-to-end operational consulting for multi-location healthcare platforms

• Post-acquisition integration, clinical alignment, and culture retention strategies

 

--Virtual Care Platform Development

• Strategy, buildout, and deployment of telehealth-enabled emergency medicine services

• Virtual care integration for ACOs, high-risk MA populations, and commercial payers

 

--Board and Advisory Services

• Strategic advisory for startups, platform companies, and digital health ventures

• Governance leadership during growth, acquisition, or transition phases

 

--Physician Engagement and Workforce Optimization

• Design of innovative staffing, recruitment, and incentive models

• Alignment of clinical leadership and operational performance to business goals

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