Health Plan Clients

How we help: Health Plan Clients

Reducing pressure on your operations; Helping you push the innovation envelope to improve member outcomes

Improve Processes

Improve Processes


Support Areas

  • Process review and improvement design
  • Workflow modeling
  • Resource planning and alignment


Typical Projects

  • 90-day rapid transformation for a specific workflow
  • Process mapping for units being integrated

Typical Key Objectives

  • Identify key process friction point within a single unit / across units using collaborative interviews
  • Produce As Is / To Be and Gap analysis for care management workflow
  • Create detailed workflow improvement plan with dependencies, due dates and resource-loading
Procurement Support

Procurement Support


Support Areas

  • New market capture support
  • Existing market renewal support
  • New program capture support


Typical Projects

  • Pre-RFP alliance building
  • Market intelligence
  • Red-team/Gold-team reviews
  • MCO Solution design assessment
  • Vendor diligence reviews
  • Readiness reviews
  • Implementation planning

Typical Key Objectives

  • Identify and engage key opinion leaders at least 12 months before projected RFP days
  • Evaluate risk of renewal loss using multi-variate model
  • Assess top vendors under consideration for capture opportunity partners and provide recommended actions
Enhance Programs

Enhance Programs


Support Areas

  • Member services redesign
  • HEDIS / CAHPS improvements
  • Operational workflow assessments

Typical Projects

  • Member persona / use case redesign
  • Performance Improvement Project (PIP) planning and evaluation
  • Plan/agency workflow integrations

Typical Key Objectives

  • Design member experience test cases for target population
  • Compile lessons learned from other plans for specific PIP profiles
  • Integrate provider call stream for multiple units
Evaluation of Vendor Solutions

Evaluation of Vendor Solutions


Support Areas

  • Diligence
  • Procurement short-listing

 

 

 


Typical Projects

  • Vendor evaluations
  • Build/Buy Analyses

 

 

 


Typical Key Objectives

  • Estimate cost and ROI of building a solution vs licensing over a 3 year lifecycle
  • Evaluate a potential vendor partner for delivery and schedule risk for proposed program

Meet Our Team Supporting Health Plan Clients

Enterprise Project Manager Read more
Advising Technology, Health Plan, Provider and Investor Clients Read more
Advising Health Plan Clients Read more
Advising Health Plan Clients Read more
Advising Rx and Health Plan Clients Read more
Advising Health Plan and Government Clients Read more
Advising Government and Health Plan Clients Read more
Partner and Practice Lead, Client Solutions Read more
Partner & Chief Growth Officer Read more
Advising Government and Health Plan Clients (LTSS focus) Read more
Advising Health Plan and Government Clients Read more

What do our clients say about us?

Here is some recent feedback from our clients:

“The Mostly Medicaid team helps us to identify innovations and market changes in a timely manner, allowing us to “course correct” as needed.” –Jeff, CEO of a Medicaid Managed Care plan

“Mostly Medicaid’s research and analysis greatly improved our depth and range in understanding the markets, specific opportunities within the markets we are pursuing, then translating the intelligence to effectively fine tune capture strategies and increase our success.” — Alex- CIO and Founder of a case management solution firm

 The Mostly Medicaid  team has spent years developing and analyzing various players in the industry and their  comparisons, opinions and insights haven’t gone unnoticed and are well executed.” — Amanda, CEO large provider network management firm


What are some recent project examples?

Example 1- Integrate Medicaid plan and county unit processes for Behavioral health members

Integrate Medicaid plan and county unit processes for Behavioral health members

Scenario

Large Medicaid plan and county health department client sough help integrating overlapping functions for MH/BH members.

Solution design

Comprehensive process review for 14 distinct functional areas, building of detailed recommendations and implementation plan

Results

Buy in for key needed changes from governing healthcare foundation for both organizations, client teams began implementing near-term enhancements immediately using resource-loaded, dependency-linked project plan

Example 2- Solution design for Medicaid health home as differentiator for health plan and win new business

Solution design for Medicaid health home as differentiator for health plan and win new business

Scenario

Health plan with commercial and Medicare footprint in state decided to puruse Medicaid health home business

Solution design

Bid support including service array, staffing and training solution design; Gold Team review; readiness reviews and staff training (post-award)

Results

New business won with 40,000 lives; Medicaid footprint established; Readiness reviews passed on first iteration

Example 3- Provider network disruption analysis in advance of plan consolidation

Provider network disruption analysis in advance of plan consolidation

Scenario

A large health plan acquired a smaller plan operating in the same region, and sought assistance for reducing member disruption as provider networks were consolidated

Solution design

Intake and analysis of provider network data, multi-variable modeling of network adequacy under differing contracting scenarios

Results

Network team was able to message to impacted providers more effectively; limited disruptions to members once integration activities began

Example 4- Behavioral Health Pharmacy Financing Analysis

Behavioral Health Pharmacy Financing Analysis

Scenario

A local plan and county government had concerns over financing mechanisms at county-owned behavioral health pharmacy

Solution design

Program audit, interviews, on site reviews, 340B compliance reviews, data analysis

Results

Cleared up decades-long confusion over use and matching of county and federal funds; implemented stronger internal controls moving forward to reduce risk


What Makes Our Approach Unique?

Our Unique Advisory Model

Our unique advisory  model

  • Focus on Key Objectives and Impact Statements ensures focus and results
  • Right amount of right brain avoids “FTE deadweight” and optimizes expertise fit
  • Project management discipline delivers results on time and on-budget AND gives client line of sight into progress
A Focus on Key Objectives

A Focus on Key Objectives

  • The so-what: We stay laser focused on your results

Example key objectives from a recent client project

How it all fits together

The Right Amount of the Right Brain

The Right Amount of the Right Brain

The So-What: You get optimized expertise and no FTE deadweight

How: our precise needs discovery model and Key Objectives focus allows for very precise expertise planning

Project Management Discipline

Project Management Discipline

 

The So What

  • Objectives Are Met
  • There Are No Surprises
  • The Work is On Time

 

 


Recent Business Insights for Health Plans

We provide valuable business insights based on our experience helping clients solve problems.


MostlyMedicaid: We can help.

We’d love to help you achieve your business objectives in the HHS space. Reach out using this form.