Payer

Provider

Market Analysis

• Assisted a payer in assessing market needs for non-insurance products
• Conducted a survey and focus group to determine levers for improving customer satisfaction, enabling a regional payer to earn a 4-star rating from NCQA
• Examined county-level medical loss ratios, market share, and broker commission agreements to enable a national payer to better understand the determinants of its performance
• Analyzed the book of business of a regional payer to enable it to predict the impact of the increased presence of health insurance exchanges in its market
• Created marketing materials for a design firm interested in promoting to payers the importance of focusing on usability and the needs of consumers
• Advised an external consulting firm on how payers are utilizing mobile health technologies

• Advised an external consulting firm on hospital formulary decision making to enable them to help a pharmaceutical company make pricing decisions
• Advised an external consulting firm on mobile health’s current and potential impact on population health management
• Advised a large investor on the implications of a strategic alliance between a hospital system and a diversified services provider

Independent Vendor Evaluation

• Evaluated a wide range of incentives a national payer could use to increase the wellness of its membership, resulting in the launch of  multiple consumer-facing services
• Advised a national payer on ways that it could assess the impact of potential wellness initiatives on presenteeism and absenteeism

• Determined the pricing and product offerings of vendors that could be enlisted to provide health services as a component of a broader healthcare service offering
• Designed a study to evaluate the clinical and financial impact of a disease management program offered by an integrated disease management services and devices provider
• Performed due diligence on potential merger partners for a financially-struggling health system
• Advised a large investor on vendors providing clinical decision support systems
• Performed due diligence on a health services supplier to enable an investor to assess whether their profit was derived from legitimate activities

Performance Improvement

• Helped a regional payer develop a retail strategy for the individual and small group markets, ending a three year trend of declining enrollment
• Conducted a survey and focus group to determine levers for improving customer satisfaction, enabling a regional payer to earn a 4-star rating from NCQA

• Evaluated the financial impact of moving physicians affiliated with an academic medical center to from volume-based payment to value-based payment
• Advised a health system on how to improve its drug formulary so that it could offer a more competitive proprietary health plan
• Devised a methodology for predicting patient-reported outcomes, enabling providers to more rapidly assess their performance
• Enabled an urban trauma center to identify situations in which it was underbilling, resulting in the identification of 2% in additional revenue
• Analyzed the impact of physician fatigue on a rural critical care center’s revenue, resulting in the identification of over $600k in potential additional revenue
• Increased patient safety at multiple hospitals by measuring, analyzing, and improving their culture surrounding patient safety
• Enhanced quality of care and improved workflow at a large academic medical center by developing a mobile application for enabling all members of care teams to track patient care through a common dashboard at the point of care