Health Solutions: Health Plans and Managed Care

Healthcare & Life Sciences

August 7, 2018

Health Plans and Managed Care Organizations continue to adapt and develop innovative solutions to the myriad of challenges in today's evolving healthcare marketplace.

Our Health Plans & Managed Care experts assist our clients with a myriad of issues facing their organizations today. Our hands-on experience and depth of understanding allows us to work closely with our clients on a host issues ranging from Core Operations, Audit & Compliance, Network Development & Contracting, Government Programs, Self-Insured Administration, Actuarial Services and Value Based Care. FTI Consulting’s Health Plan & Managed Care services include:

Health Plan Operations

Our client base spans the entire the health plan spectrum, from local and regional managed care organizations to large, national health plans. We assist our clients in virtually all aspects of health plan operations, often working directly with the C-suite executives on areas such as strategy, operational alignment and administrative efficiency. Our range of services include Core Administration, Audit & Compliance, Network Contracting, Actuarial, Pharma and Data Management.

Strategic Programs

Our health plan and managed care clients often have a diversified membership base, supporting multiple strategic programs and business units, including Commercial, Medicare Advantage, Managed Medicaid, Affordable Care Act, Exchange and Self- Insured Administration. Our team of experts assists our clients in achieving their overall strategic business objectives, including efforts to support strategy, operational transformation, risk adjustment, coding accuracy, actuarial, network adequacy, delivery system reform (DSRIP) and rate filing adequacy.

Value Based Care

The healthcare marketplace continues the transformation from a fee-for-service based model to one based on value where cost efficiency, quality of care and member experience are equally emphasized. Health plans and managed care organizations are forging new relationships with providers focused on population health, accountable care (ACOs), clinically integrated networks and alternative reimbursement models. We help our clients adapt to the ongoing changes in value based care working collaboratively with our clients to develop solutions driven by leading practice tools, strategies and initiatives.

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