Elevate Your Clinical Practice

For more than three decades, we have worked with some of U.S. healthcare’s most innovative healthcare professionals (HCPs) and healthcare provider organizations (HPOs)–making strategic use of healthcare’s volume-to-value (V2V) transition to improve clients’ clinical, financial, and administrative performance, outcomes, and impacts.

To improve your revenues, earnings growth, and competitiveness, we…

• analyze your market, organization, and service lines;
• help you design and implement winning strategies around the efficient and effective prevention, diagnosis, and treatment of targeted conditions with unduly high incidence and prevalence; and
• ensure you generate better economic, clinical, and humanistic outcomes (ECHOs) than the competition.
  

Our team has a broad and deep understanding of strategic coding, medical recordkeeping, letters of medical necessity (LMN), step-therapy requirements, prior authorizations, predeterminations, evidence-based billing, electronic claims management, evidence-based appeals to reverse denials and/or win coverage exceptions, value-based payment (VBP) negotiations, real-world data (RWD) collection, real-world evidence (RWE) building, and proof-of-value (POV) reporting under value-based contracting (VBC) and outcomes-based compensation (OBC) agreements, and social-impact initiatives.

Offering analytic, strategic, and hands-on support, we serve clients large and small, in…

• primary care practices (PCPs), advanced clinical specialties, and onsite/near-site clinics supporting major employers;
• community hospitals, regional health systems, and multi-state integrated delivery networks (IDNs); and
• primary care super clinics (PCSCs), patient-centered medical homes (PCMHs), and accountable care organizations (ACOs).
  

Whether your market is dominated by fee-for-service (FFS) payment models or value-based payment (VBP) models, we understand the clinical, financial, and administrative imperatives and can help you outperform the competition.

We do that by:

• researching population health trends, evaluating the healthcare cost challenges facing health plan sponsors and healthcare purchasers in your region (e.g., fully insured and self-insured employers and unions), and studying the competitive landscape;
• focusing on the most critical community health risks, mapping out benefit plan design and the patient journey, and helping you rethink, reorient, and reengineer your organization to align with the pain points, needs, and aspirations of the populations you serve; and
• enabling you to realize peak clinical, financial, and administrative performance, outcomes, and impacts by focusing on the metrics that matter most.
  

Our clients experience a 20% to 35% increase in revenue during the first 90 days of partnering with us—all while maximizing the quality of patient care, patient-reported outcomes (PROs), and net promoter scores (NPSs).

Count on us to help you offer the individuals, organizations, and communities you serve consistent and measurable improvements in their wellbeing, productive capacity, and socioeconomic status…so you get the results you want and need.

Our visionary, practical, and highly effective consulting experts will guide you step-by-step through practice development, practice management, and practice-based research (PBR) so you can protect and enhance your revenues, operating efficiencies, and earnings growth as U.S. healthcare makes the volume-to-value (V2V) transition.

We’ll help you design and implement winning clinical, financial, and administrative strategies across your organization—and ensure your teams are on board, as well.

We will:

• analyze the populations, healthcare purchasers (e.g., employers), and third-party payers (TPPs) you serve to improve alignment between your practice areas or services lines and what your customers most want and need;
• evaluate the numbers behind your business (e.g., key performance indicators [KPIs]), implement the right dashboards and scorecards to keep you on top of the essentials, and support you in continuously improving your business policies, structures, systems, processes, procedures, standards and practices so your operations are more efficient and effective; and
• measure your economic, clinical, and humanistic outcomes (ECHOs) across multiple metrics (e.g., patient, provider, payer, prescribed product, plan of care) so you have leverage in getting the payment you deserve (e.g., via statements of medical necessity [SMNs], step therapy plans, prior authorizations and predeterminations, evidence-based billing and denial management, appeals and value-based payment (VBP) negotiations, value-based contracting (VBC) and outcomes-based compensation (OBC) agreements, and more.

We’ll look at everything…

• from the incidence and prevalence of conditions in your community or cohort to your practice portfolio or service lines;
• from patient and specialist relationships to purchaser and payer relationships; and
• from market insights and practice implications to financial imperatives.

Count on our interdisciplinary team of practice development, practice management, and practice-based research (PBR) veterans to help you maximize the potential of your enterprise, prepare for exponential growth, and become a leading niche or general service provider in your markets.