Our Services for Health Plans

Our health plan clients range in size and market coverage.

We work with large national, regional, and statewide plans, as well as provider-sponsored and smaller niche plans, to help them address the complex challenges in the business of healthcare. From strategy development to implementation support, our engagement teams support a wide variety of critical initiatives within Commercial, Employer and Government Markets to cultivate lasting value.

Healthcare Value Transformation

Healthcare affordability and value-based care are central to strong enterprise performance. We can help you realize the value your members and key stakeholders demand.

Our teams have extensive experience designing and executing tailored care management and value-based strategies that help transform legacy business models and improve performance in a market environment accelerating towards value-based and integrated care. HealthScape helps our clients with:

  • Provider network strategies and value-based model design
  • Provider partnership and contract development support
  • Payer/provider clinical program design and implementation
  • Care management strategies and care model design
  • Behavioral health operational and delivery system transformation
  • Pharmacy management strategy and model development
  • Capability and vendor assessments to enable performance improvement
  • Analytics, benchmarking, and performance monitoring
  • Internal resource and change management strategies
  • Implementation and integration support


Senior Markets Growth and Performance

Senior Markets—Medicare Advantage in particular—represent a significant opportunity for our health plan clients.

Our teams work closely with health plans to capture the opportunity offered by this growing market segment, evaluating the full continuum of alternatives for entry, growth and performance improvement. We help our clients with:

  • Medicare Advantage and Medicare Advantage SNP market entry
  • Senior market migration strategies
  • Short- and long-term strategic planning
  • Organizational and operating model design
  • Vendor and partnership evaluation
  • Stars improvement and other revenue enhancement initiatives
  • Care management and value-based models tailored for Medicare Advantage
  • Operational efficiency improvement
  • Medicare product design and portfolio management


Government Programs Lifecycle Support

HealthScape partners with our clients throughout the entire government contract lifecycle for both Federal and State-based healthcare programs.

We are recognized experts in helping our clients with the end-to-end strategy, capture, and execution related to major government healthcare program opportunities. Our services encompass initial opportunity evaluation, partnership evaluation, proposal and application development, implementation management, and ongoing performance improvement support services. The full spectrum of our government program expertise includes:

  • Medicaid Managed Care programs, both traditional and specialty carve-out
  • Dual-eligible programs and pilots
  • Medicare Advantage and Medicare FFS contract opportunities
  • Center for Medicare & Medicaid Innovation programs and pilots
  • Military healthcare, including TRICARE and Veterans Affairs

Business Strategy & Performance Improvement

We specialize in helping our clients thrive in the business of healthcare.

Our broad market experience and health plan expertise position us to drive strategic growth and performance improvement initiatives for our clients. We help health plans grow sustainably, enhance revenue, generate cost savings, and improve their overall performance profile. HealthScape can help with:

  • Market assessments and business plan development for new opportunities
  • Diversification strategies across the continuum of ancillary offerings (e.g., dental, vision, life, disability and workforce, wellness)
  • Partnership/vendor evaluation and implementation support
  • M&A transaction and integration support
  • Organizational restructuring and operating model design
  • Capability gap assessments and remediation
  • Operational efficiency, process design and re-engineering
  • Advanced analytics and performance monitoring
  • Drug cost management strategies