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Operations Assessments & Implementation
 

Presscott Associates can position your healthplan for success by reviewing its operational readiness and offering the attendant strategies and tactics for improvement. We can assist your organization in the enhancement or development of protocols for monitoring the flow of information to improve the management reporting process, the evaluation of operational performance, and the improvement of margins and customer service. During its assessments, Presscott Associates reviews key inter-departmental interfaces and functional accountabilities as well as the use of best practices and technology to optimize medical expense controls and operational efficiencies.

Most healthplans are currently faced with the challenge of operating efficiently in an environment of tightly-managed cost structures, the existence of variability in provider contract terms and a need for continual cost-benefit assessment concerning medical management. Presscott Associates has extensive experience in performing operations reviews that identify the modifications required for efficient provider contract management and medical management efficacy.

We offer strategies to implement necessary operational modifications with minimal organizational disruption. We focus on provider network functions such as member eligibility, pre-authorizations and referrals, provider reimbursement and education, credentialing and claims payment. The flow of information to and from your health plan and network providers is reviewed to identify ways to improve network relations and to educate network providers regarding managed care requirements. We offer an implementation-oriented approach that can also position health plans for new or existing Pay-for-Performance programs.

The medical management functions are often a focal point of our reviews. As health plan’s reassess the marketability and cost-benefit of their medical management programs, Presscott Associates can assist in evaluating the impact of a health plan’s current medical management protocols and, if appropriate, modify or design a more efficacious program. During this process, Presscott Associates recommends specific methods to refine pre-authorization programs, referral requirements, reimbursement models (including Pay-for-Performance programs) and communication linkages to maximize your medical management program’s value and provider satisfaction.

Our operations reviews often result in the development of medical and administrative expense benchmarks, and identify opportunities for process standardization to increase operating efficiency, minimize payment disputes and reduce administrative overhead expenses.

It takes less time to do a thing right than it does to explain why you did it wrong.
-- Henry Wadsworth Longfellow --

  
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