Financial Enhancement Plan for a Growing Health Plan

Our Client required assistance in design and execution of a financial turnaround plan. We provided intensive assistance with staff on the ground for six months. We analyzed the root causes for significant financial losses that were incurred, including analysis of medical costs, operations, and revenue challenges.

Upon identification of ten areas of specific impact, we developed and executed a Financial Enhancement plan that included:

• Medical claim and PBM audits
• Re-contracting of hospitals
• Physician fee-schedule adjustments
• Significant medical payment policy adjustments

A Balanced Scorecard performance management system was introduced, as well as a business intelligence system for detailed metrics for operational reporting and analysis.