Health plans and managed care organizations continue to adapt and develop innovative solutions to the myriad challenges of today’s evolving healthcare landscape.
How We Help
Our hands-on experience covers a variety business lines (e.g., Medicare Advantage, Managed Medicaid and commercial), and our depth of understanding of the goals and needs of each type of stakeholder (i.e., payers, providers, patients, third parties, regulators) is comprehensive. This allows us to work closely with you in a host of areas, such as core operations, audit and compliance, network development and contracting, government programs, antitrust, competition and market assessments, self-insured administration, actuarial services and value-based care.
Our range of health services supports the managed care stakeholder spectrum — from local and regional managed...
Our range of health services supports the managed care stakeholder spectrum — from local and regional managed care organizations to large, national health plans, providers taking on risk under capitated, delegated contracts, and third parties providing key services to each of these types of entities. We can assist you in virtually all aspects of health plan and related managed care operations in the Medicare Advantage, Managed Medicaid and commercial space, often working directly with C-suite executives on areas such as operational improvement, patient and provider engagement, data analytics, strategy, compliance, operational alignment and administrative efficiency. Our services also include core administration, audit and compliance, network contracting, actuarial, pharmaceuticals, transactional due diligence, and data management.
The healthcare marketplace continues to transform from a fee-for-service model to one based on value in which...
The healthcare marketplace continues to transform from a fee-for-service model to one based on value in which managing risk, cost efficiency, quality of care and member experience are equally emphasized. Health plans and managed care organizations are forging new relationships with providers, focusing on population health and risk adjustment, accountable care organizations (“ACOs”), clinically integrated networks and alternative reimbursement models. We help you adapt to the ongoing changes in the value-based model, working collaboratively to develop solutions driven by leading practice tools, strategies and initiatives.
Health plan and managed care organizations often have a diversified membership base, supporting multiple strategic...
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 can assist you in achieving your overall strategic business objectives, including efforts to support strategy, operational transformation, risk adjustment, coding accuracy, actuarial, network adequacy, Delivery System Reform Incentive Payment (“DSRIP”) and rate filing adequacy.