Ø Medical Management Support
o Integrated care coordination workflow processes and systems
o Seamless information technology platforms
o Case load calculator (adjusts for patient acuity, intensity of the medical management intervention and contract requirements to efficiently assign case loads to care managers)
o Administrative, clinical and financial reports and scorecards
o Policies and procedures
o Automated health risk assessment tools that generate customized care treatment plans
o Integrating clinical protocols, pay-for-performance measures, and national standards into the medical management process
o Integrating LOINC, medical and pharmaceutical claims into unified data management platform
o Education and training (including customized onsite workshops)
Ø Financial & Benefit Management
o Medical bill review
o Recovery of overpayments
o Access to re-pricing networks
o Benefit analysis and modeling
o Financial projections
o Actuarial certification of IBNR
o State rate filings
o Annual statement certifications
Ø Medical Management Decision Support Tools
o CM, DM and UM software application support
o Data warehouse and reporting applications
o Predictive modeling analysis
o Admission, LOS, and discharge support services
o Specialty pharmaceutical management
o Medication therapy management programs
Ø Quality Assurance and Performance Improvement Programs
o Audits and peer review of medical management operations
o QA/QI program support
o Identification, implementation, measurement, and re-assessment of clinical, financial and performance outcomes
o Patient safety initiatives
o Accreditation preparation
Ø Legal Support
o Government affairs
o Lobbying
o Public policy development
o Mergers and acquisitions
o Audits and due diligence reviews
o Regulatory compliance
o Corporate law/governance
§ Risk management support
§ Joint venture/partnership – strategic, analysis, negotiation and drafting
§ Corporate professional liability assessments
§ Bylaws
§ State corporate filings
o General legal consulting
§ Litigation management
§ Contract negotiation and drafting
§ Establish internal contract standards and processes
Ø Research
o Research and data analysis
o Medical management and health plan business trends
o Identification of clinical and financial trends
o National utilization benchmarking
o Development of enhanced outcome reporting systems
o Technology assessment
Ø General Business Support
o Software and hardware support
o Business development and marketing strategies
o Operational and financial analysis
o Identify best practices, cost savings, and effective/complimentary market offerings
o Communication program and materials
o Requests for proposal (RFPs)
