Health Plan Services
Supporting Value-Oriented Operations and Innovations in Member and Provider Engagement
Health Value Associates provides guidance and support to health plans as they improve performance-driven and value-oriented operations, member experience, and provider relationships. We help them develop and manage projects and programs that drive innovation, collaboration, and partnerships with medical practices, health systems and provider networks as they transition from fee-for-service to fee- for-value. These efforts are important as providers and their care teams begin to fully operationalize value-based care, and as community organizations engage with all stakeholders to support population health.
Health plans are facing post-pandemic and other challenges such as shifts in member populations and payment paradigms, requests for accelerated value-based arrangements, and pressures in managing MLR. They also need to navigate virtual care and digital transformation and to comply with transparency in coverage and pricing regulations. These challenges impact business, operational, clinical, technical, and digital strategies and their timely, collaborative execution.
Organizations served by Health Value Associates include commercial health plans, Medicare/Medicare Advantage, and Medicaid health plans, along with the insurance carriers and management services organizations that support them.
- Enterprise and organizational unit strategic planning
- Data, analytics, and reporting frameworks
- Interoperability and alignment of IT and analytic solutions
- Population health and care coordination strategies
- Value-based program expansion
- SDOH and behavioral health
integration - Member/consumer outreach and data access strategy
- Transparency in coverage planning & reporting
- Provider/physician engagement
- Provider collaboration and
partnership frameworks - Digital transformation strategy
- Empowering and leveraging existing resources
- Alignment of business objectives, strategies, and tactics
- Data and Analytics capability assessment and gap analysis
- Population Health capability assessment and gap analysis
- Tracking and forecasting multiple value-based contracts
- Provider network and referral analysis
- Quality & performance improvement opportunities
- Provider best practice adherence
- Cost-of-care reduction opportunities
- Payer/provider/community market dynamics
- Payer-provider marketplace evaluation
- Value-based opportunity assessment
- Strategy alignment and execution
- Implementation plans and investment roadmaps
- Innovation development and adoption
- Performance dashboards and KPI development
- Claims/clinical data exchange and integration
- Provider quality and performance benchmarking
- Provider performance & financial impact analysis
- Digital health enablement and Integration
- Risk profiling and stratification
- Predictive analytics applications
- Care coordination and care management
- Episodic and total cost-of-care analysis
- Data management and analytic tool consolidation
- Enterprise analytic process standardization
- Advanced risk assessment and impactability
- Risk adjustment and HCC optimization
- Provider network and care process optimization
- Quality and performance improvement
- Population health management program improvement
- Cost-of-care reduction
- Managing MLR
- HEDIS reporting and STAR ratings improvement
- Physician network development and optimization
- Provider contract performance improvement
- Concurrence on defining and measuring “value”
- Harmonizing quality, utilization, and cost metrics
- Alignment of IT, data, and analytics teams
- Physician and patient collaboration portals
- Best practice sharing and collaborative learning
- Payer-provider joint analysis and insight sharing
- Community and community health engagement
- Collaboration development and evaluation
- Enterprise and external collaboration management
- Payer-provider alignment and collaboration
- Business intelligence and competitive analysis
- Business planning and impact analysis
- Performance and financial forecasting
- Vendor profiling, selection, and engagement
- Value-based care and payment frameworks
- Provider network expansion
- Payer-provider partnerships and joint ventures
- Data sharing and data use agreements
- Community partnerships and strategic alliances
- Opportunity analysis and due diligence
- Contract development and negotiation
Samples of Payer/Health Plan Successes
Data & Analytics Strategy Supporting Operations and Population Health Management
Provider Collaboration Supporting Performance Improvement and Value-Based Contracting
Revitalizing and Expanding a Value-Based Care and Reimbursement Program
Population Health Management and Cost-of-Care Reduction Program Enhancement
Clinical Data Exchange and Integration Supporting Value-Based Contracting and HEDIS/STAR Reporting
Harmonizing Quality, Utilization, and Experience Metrics Across Multiple Health Plans and Provider Practices
Operational Support and Provider Collaborations to Improve Care Processes, Outcomes, and Cost