An approach that uses a data driven analytics strategy focused on lowering health care costs and improving productivity by identifying the underlying issues, cost drivers and subsequently defining, quantifying and narrowing the strategic options.
Identify Cost Drivers of Health Care and Time Loss Using Data Analytics
• Diagnostics
+ Financial Structure / Funding Methods
+ Operational Issues / Contracted Vendors
+ Eligibility Provisions / Plan Design Considerations
+ Clinical Conditions / Population Illness Burden
+ Utilization Statistics / Provider Contracts
+ Member Demographics / Satisfaction Levels
+ Prescription Drugs / Pharmacy Benefit Management
+ Medical Provider Networks / Pharmacy Networks
• Benchmarks
+ Period Over Period Adjusted Results
+ Costs and Utilization Statistics to Block of Business
+ As Needed External and Peer Groups
Analyze Dimensions for Gaps and Variances / Draft Road Map
• Plan Design
+ Eligibility Provisions to Coverage Mandates
+ Value Based Designs to Health Contingent Wellness Programs
+ Broad or Tiered Networks to Maximum Allowable Pricing
+ Account Based Plans and Minimum Value Compliance
• Finance and Funding
+ Self-Funding and Creative Reinsurance Structures
+ Alternative Risk Transfer and Captive Feasibility
+ Employer Targets and Optimizing Employee Contributions
• Population Health Management
+ Well, At Risk, Chronic and Catastrophic Program Management
• Operations
+  Vendors, Business Process Outsourcing, Business Process as a Service
Develop and Simulate Mapped Options and Structure Decision Support Models
• Real Options Frameworks
+ Options Framework and Logic
+ Scenario Analysis
+ Monetary Valuation
+ Simulation of Results
• Financial Models
+ Discounted Cash Flows and NPV
+ Optimization/Attachment Points
• Project Management
+ Action Items
+ Resource Requirements
+ Critical Paths
• Assumptions
     + Internal and External
Present Recommendations and Implement Decisions on Strategic Options
Well Structured Road Maps
+ Survey of Options
+ Considered/Eliminated
+ Retained/Recommended
Risk Assessment
+ Change / Status Quo
Project Management
+ Scope / Resources / Timeline / Milestones
+ Manage Stakeholders
+ Monitor / Control Risk
Vendor Management
+ Retain / Select Vendors
+ Negotiate Terms / Establish Agreements
+ Monitor Performance / Manage Stakeholders
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