Health Plan
DoD/CHAMPUS rate development and bidding
- Quarterly reviews
- Year-end reviews
- Statements of opinion
- Auditor support
- Plan performance
- Provider contracting levels
- Expense levels
- Disease management programs
- Methodology assessment
- Assessment of Value (ROI)
- Practice guidelines usage
- Predictive modeling
- Pharmacy Management
- Health and wellness programs
Medicare Advantage
- Rate development
- CMS filings
- Benefit design
Operations review
- All departments
- Staff level assessments
- Performance review and improvement
Organizational assessments
- Reporting structures
- Due diligence
- Methodology selection
- Integration with medical management
- Integration with underwriting
Provider contracting
- Market assessment
- Contracting methodologies
- Provider profiling
Rate Filing
- Review of internal documentation process
- Filing with regulators
Rate Manual Development
- Pricing basis
- Actual/Expected analysis and reporting
- Benchmarking
Reinsurance and risk management analyses
Risk Adjustors
- Effectiveness assessments
- Selection of risk adjustor methodology
- Negotiate with vendors
- Health and wellness programs
Strategic Planning
- Business planning
- Risk adjusted surplus allocations
- Managed care strategy
- Merger/acquisition support
Tiered Networks Benefit Programs
- Tiering design and methodology
- Communication assistance
Underwriting Review
- Process review and improvement
- Predictive modeling integration
- Small group medical underwriting process and methodologies