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Medimetrix has worked with over 100 health insurers and managed care companies and completed in excess of 500 projects. We work to improve a health plan's overall strategic and financial performance by evaluating current market conditions to identify strategic opportunities. We have also had a niche in the provider health plan sector for over twenty years and have worked with most of the existing, intact plans of today.
At the Cutting Edge …
The next generation of provider risk sharing including “soft cap,” package pricing and other payment “reform” initiatives.
A Regional Blue Cross Plan
Facilitated a strategic and financial plan including complete product portfolio review and market segmentation strategy. Facilitation results in the client taking on as much of the work as they can and Medimetrix organizing and managing the work.
A National PPO
Developed partnerships and acquisition strategies. This is a typical project for stand-alone insurers.
Provider Sponsored Health Plans
A typical product involves quantifying health system benefits and alignment niceties or the underlying business relationship.
Community-Owned, Not-for-Profit HMO
We prepared a five-year strategic marketing plan based on a review of the statewide competitive situation in commercial, Medicare and Medicaid programs. Our research identified specific market opportunities in each of these product areas on a county-by-county basis. We also evaluated the potential for defined contribution, self-funded and medical savings account product opportunities. As part of our recommendations, we offered three marketing/communications positioning platforms for management consideration.
Medium-Sized Provider-Sponsored HMO
We analyzed the financial, clinical and strategic benefits of an HMO owned by an integrated health system to assist management in understanding the strategic differences of the health plan in important geographic markets within the integrated system. We conducted a two-day retreat for key decision-makers where the underlying fundamentals were considered using our Interdependency Grid to evaluate key relationships.
Midwest Provider-Sponsored Health Plan
We conducted a high-level operational assessment of the finance division. Medimetrix reviewed financial documents and interviewed key members of the management team. We presented strategic and operational findings that were assigned high (action required within 90 days), medium (action within 90 to 180 days) and low (action within a year) priority levels and we indicated specific areas for improvement for each of our findings.
Large, West-Coast Provider-Sponsored Health Plan
We assisted management of an integrated health system in the evaluation of a five-year business plan that included a unique method of valuing the inter-relationships between system components. The inter-relationships were defined by our Interdependency Grid, which served as a basis to quantify and qualify strategic, financial and clinical factors.
A Large National Mutual Insurance Company
We conducted an analysis of a potential joint venture with a regional PPO and were directly involved with investor and provider negotiations. We also performed a regulatory analysis of possible options.
A Provider-Sponsored MCO
We conducted a feasibility assessment for an HMO, prepared the COA, and facilitated the purchase and integration of other lines of business. Our work also guided management's considerations for a joint venture with a large HMO. We assisted the client in a corporate reorganization that included a physician equity buy-out.
A Large Multi-Market Health Plan
We conducted HMO and PPO operational assessments with subsequent recommendations that improved the organizational structure and operating efficiencies. As part of our work, we evaluated the functionality of the client's information systems to ensure the capability to handle increased enrollment and reporting requirements.
A Catholic-Sponsored, Statewide Medicaid HMO
We redesigned billing and remittance systems and converted from an external TPA to a full-service, in-house capability.
A Full Product Line Insurance Company
We completed an organizational assessment aimed at decreasing costs and increasing efficiency, and developed a five-year financial projection demonstrating the impact of our recommendations.
A Statewide Blue Cross Blue Shield Plan
We helped secure approval for a Medicare Choices Demonstration Project from HCFA and designed risk-based PPO products for Medicare beneficiaries. As part of understanding design features, we conducted focus groups and assisted with the implementation of this new product.
A Provider-Sponsored HMO
We developed Medicaid strategies, designed a child health program and prepared an application to state authorities that was recognized as one of the "best state applications".
A 500,000+ Member Regional Staff Model HMO
We evaluated relationships between a staff model HMO and a large medical group to identify potential opportunities. Our work included a reorganization of the HMO to improve operational efficiencies. We created a structure for a joint venture between an integrated delivery system and provider-owned health centers and helped to implement the joint venture.
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