Health Plans and Managed Care
FTI Consulting health plan and managed care experts help our clients with a myriad of issues facing their organizations today. Our hands-on experience and depth of understanding allow us to work closely with clients on a host of issues such as core operations, audit and compliance, network development and contracting, government programs, self-insured administration, actuarial services, and value-based care.
Health Plan Operations
Our range of health plan services supports the entire health plan spectrum, from local and regional managed care organizations to large, national health plans. We assist our clients in virtually all aspects of health plan operations, often working directly with the C-suite executives on areas such as strategy, compliance, operational alignment, and administrative efficiency. Services include core administration, audit and compliance, network contracting, actuarial, pharma, and data management.
Health plan and managed care organizations often have a diversified membership base, supporting multiple strategic programs and business units, including Commercial, Medicare Advantage, Managed Medicaid, Affordable Care Act, Exchange, and Self-Insured Administration. The FTI Consulting team of experts assists our clients in achieving their overall strategic business objectives, including efforts to support strategy, operational transformation, risk adjustment, coding accuracy, actuarial, network adequacy, delivery system reform (DSRIP), and rate filing adequacy.
Value Based Care
The healthcare marketplace continues the transformation from a fee-for-service based model to one based on value in which cost efficiency, quality of care and member experience are equally emphasized. Health plans and managed care organizations are forging new relationships with providers focused on population health, accountable care organizations (ACOs), clinically integrated networks, and alternative reimbursement models. We help our clients adapt to the ongoing changes in the value-based model, working collaboratively to develop solutions driven by leading practice tools, strategies, and initiatives.
Senior Managing Director