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Medimetrix has worked
with over 100 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 assess operational efficiencies and
staffing levels, review financial performance, reporting and compliance
issues and specialize in the integration of business objectives between
provider-owned health plans and their provider owners. We also furnish
professional interim management services to HMOs and health plans to
achieve specific turnaround objectives.
Our
recent projects include:
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 considerations.
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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