Many organizations, including hospitals, nursing homes and physician group are seeking to launch at-risk programs and health plans for Medicaid, Medicare, Special Needs populations and Health Benefits Exchanges.

 

They are uncomfortable with their patient populations being dominated by a few large commercial carriers.  However, regulatory requirements and infrastructure costs are making it increasingly difficult for local health plans to survive, no less compete with larger, well capitalized organizations.   At the same time, recent developments have added new and expensive beneficiary populations to managed care, requiring all organizations serving government programs to accumulate significant capital to support increased enrollments, revenues, and risk.

Consequently, the remaining smaller local plans or provider organizations that serve these populations are at risk of being squeezed out of the market or are essentially required to sell to larger organizations.  At the same time, local plans and providers may be better positioned to effectively coordinate the care of the target populations because they are more familiar with the local health care environment, patterns of care and social services alternatives.

In many ways, health care is – and should be – local.  Clear View Solutions can help these plans and provider groups by providing access to administrative services, infrastructure and coordinated care expertise membership. Clear View Solutions can deliver these services at a price point comparable to plans with much larger membership.

Clear View Solutions is designed to serve the needs of this segment of the market through expert consulting services combined with a packaged offering of care coordination programs and BPO services. Offerings include:

  • Access to the experience and expertise of operating professionals in the Special Needs Plans space
  • Tools, programs and services to evaluate opportunities and markets
  • Analytics, reporting and HIPAA compliant data warehouse capabilities for all aspects of program evaluation and management
  • Access to administrative systems through our vendor partners that handle all aspects of administration (enrollment, claims, customer service) as well as care coordination
  • Services include both pre-operational assistance as well as a comprehensive suite of turnkey services for all aspects of operations.

The potential market for new at-risk organizations is active and robust.

In 2015 alone, there are over 25 new Medicare Advantage organizations with over 50 benefit plan ids.  While there are numerous organizations that address various components of health plan requirements, few organizations offer a comprehensive suite of services, affording a rapid market entry by Clear View Solutions.