How We Help

• New Product and Design Strategy for Payers, Providers, & Startups. Ensure best-in-class virtual care user experiences with patient centricity and consumer-centric design principles.

• Business Model Innovation. Develop and refine GTM strategies for unique virtual clinic service lines and business models including B2B, B2C, B2B2C, Risk-Bearing, Distribution Partnerships, and Two-Sided Networks.

• Virtual-First Product Strategy. Create and enable virtual-first health plans, health system digital front doors, and virtual longitudinal care clinics (primary and specialty care).

• Health System Operations & Performance. Improve provider recruitment, retention, integration, workflow, and best practices for virtual-only, hybrid, and at-home care models.

How We Help

• Provide End-to-End Strategies for Health Systems, Payers, and Hospital-at-Home Vendors. Optimize reimbursement with high-performing and efficient operating models for RPM and care-at-home programs.

• Create New Use Cases & Business Models. Evaluate and develop new use cases for RPM device categories including: CGMs, BP cuffs, vital sign monitoring systems, digital scales, CPAP machines, spirometry, handheld exam kits, remote ECG systems, on-demand home lab kits, and fitness/wellness trackers.

• Build, Optimize, and Expand. Build and optimize care-at-home-programs for common conditions (MI, CHF, CKD, Pneumonia) and expand into new programs in palliative care, home infusion, dialysis, and self-administered treatment.

• Medicare and VBC Readmission Prevention Programs. Build & optimize care-at-home models for Medicare and Value-Based Care programs to prevent readmissions.

How We Help

• Define 3-5 Year Strategic Roadmaps. Create long-term value with strategies to expand patient access, improve clinical outcomes, optimize medication adherence, and enable value-based care initiatives using DTx and digital care programs.

• Product Design and GTM Strategy. Evaluate and expand DTx categories, SaMD, and digital medicines with product development, clinical trial design, and market access strategies including provider awareness/uptake and evidence requirements for payers.

• BioPharma Digital Medicine Initiatives. Serve as trusted advisors to Heads of Digital Health at global biopharmaceutical companies for DTx strategic and external partnerships, product design, MVPs, building for scale, clinical trial design including real-world outcomes data capture, SaMD product development, and navigating global regulatory bodies and the regulatory landscape.

How We Help

• Sales Models. Improve value proposition for payers with sales strategies that answer payers key questions quickly, precisely, and efficiently including expected MLR /Cost of Care analysis, provider/user demand, clinical data requirements, and policy implications.

• Payer Business Development. Help create new strategic partnerships, increase sales, and drive robust pipeline opportunities with payers, PBMs, and TPAs using our payer business development models that leverage proprietary databases of robust existing payer relationships, payer C-suites, and health system executives including CXO/CIO relationships.

• Business Model & GTM Strategy. Provide expertise in diverse digital health business models and reimbursement strategies including B2B, B2C, B2B2C, Risk-Bearing, and VBC. We help advise clients on identifying, negotiating, contracting, and implementing strategic payer partnerships to deliver products that help payers support their clinical strategy, operations, and compliance goals.

• Strategic Planning, M&A, and Partnerships. We advise digital health startups and their investors on corporate strategic planning, annual operating plans, board of directors materials, and long-term contracted network growth strategies for payers. In addition we provide client services to help generate, manage, and execute M&A, investments, and strategic partnerships with payers, leading digital health startups, health systems, and biopharmaceutical companies.

How We Help

• Automation of Core Processes. Provide strategic consulting and operational planning to fully automate core processes using AI-enabled and ML powered solutions for prior-authorization, medical necessity, utilization management, claims management, auto-adjudication, cybersecurity threats, and privacy data management.

• Build World-Class Member Experiences. Deploy strategies and methods from the best DTC brands to build world-class experiences for health plan members. Utilize consumer-centric design principles to improve customer service, increase member engagement and customer satisfaction, and sustain brand loyalty from leading brokers and agents.

• Digital Health Solution Evaluation. Assess Build/Buy/Partner capabilities and opportunities with digital health solutions for sales/enrollment/retention, member engagement, utilization management (imaging, infusions, ambulatory surgery care), length of stay, preauthorization, and population health management.

How We Help

• Consumer-Centric Product Design and Strategy. Ensure consumer-centric products also drive strategic value with end-to-end experiences that improve performance in member experience, quality of care, population health outcomes, and quality metrics (CMS Star rating, HEDIS, CQMs, etc.)

• Innovative Benefit Designs. Deep domain expertise in innovative product designs including Virtual Only and Virtual-First Benefits, Value-Based Insurance Design (VBID), HDHPs, Reference Pricing, Tiered Networks, Risk-Bearing, Value-Based Care Programs, and risk adjustment optimization products. Identify and assess use cases with potential digital health partners for digital and strategic initiatives.

• Product Development and Modeling. Optimize for speed, flexibility, and favorable MLRs by combining Agile product development frameworks with risk mitigation from actuarial analysis and modeling. Test products with modeling in multiple markets including fully-insured, self-insured, individual, small and large group, health insurance exchanges, and Medicare Advantage.

How We Help

• VBID Design. Increase healthcare value for payers, employers, and government stakeholders with Value-Based Insurance Design principles for products, benefit designs, and programs that incorporate innovative cost-sharing structures to increase high value care, reduce low value care, and improve member experiences.

• VBID Implementation and Evaluation. Provide strategic consulting for the design, implementation, and evaluation of Value-Based Insurance Design (VBID) models in diverse markets and product segments including fully-insured, self-insured, individual, small and large group, health insurance exchanges, and Medicare Advantage. Leverage VBID expertise to improve medical loss ratios and ensure successful new VBID product launches with evidenced-based research, robust datasets, provider input, and clinical nuance.

• VBID in Medicare Advantage. Refine multi-year strategic roadmaps for MA health plans to leverage new VBID flexibilities and create competitive advantages in the MA market with CMS’s Medicare Advantage (MA) Value-Based Insurance Design (VBID) Models. Anticipate future developments and opportunities by assessing current MA VBID programs and the competitive landscape. Create first-mover advantage to improve risk adjustment and MLRs by quickly operationalizing new VBID programs that can incorporate socioeconomic status (i.e. SDoH) and chronic conditions into novel benefit designs.

How We Help

• Model Design and Support. Design and develop novel performance strategies for ACOs and bundled payment models to identify variations in outcomes, quality, cost of care, and evidenced-based guidelines. In addition, we provide clients with strategic support for deploying, monitoring, and refining VBC models that leverage IPA risk-bearing, clinical and cost centers of excellence, integrated practice units, and multidisciplinary team-based approaches to clinical care pathways and care cycles.

• AI-powered solutions and Advanced Analytics. Identify and deploy advanced analytics and innovative AI-enabled tools to track outcomes and costs for risk bearing contracts, enable Patient-Reported Outcome Measures (PROMs) Dashboards, and monitor payer reimbursement. Build and utilize data integration from Payers, Providers, PBMs, and Health Systems (i.e. claims, clinical outcomes, predictive analytics, and customer satisfaction data sets) for Patient-Centric, Payer-enabled dashboards and analytics to support health systems and providers.

• Medicare Programs. Provide strategic support for Medicare hospital-based VBC Programs including the Hospital Readmissions Reduction Program, Hospital Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program.

How We Help

• VBC Contracting Design and Modeling. Financial and actuarial modeling for risk-bearing contracts that utilize narrow network designs, ACOs, independent physician groups, IPAs, Medicare Shared Savings Program, and new models of comprehensive referral networks for speciality care, post acute care, home health, and ancillary services (e.g. physical therapy). In addition, we provide strategic support for provider group acquisitions and mergers to ensure successful integrations and transformations.

• Contract Analysis. Contract and negotiation support using data-driven models for implementation, refinement, and evaluation of Value-Based Care Contracts including market analysis, covered benefits and services, performance measurement and timelines, data reporting, payment terms and timelines, provider participation requirements, and past performance/ history trend.

• Health Equity Promoting ACOs. Strategies for design, deployment, and evaluation of ACO Realizing Equity, Access, and Community Health (ACO REACH) models including culturally appropriate digital health solutions to identify SDoH in underserved ACO populations.