Dual Eligible Special Needs Plan Launch
A group of Long Term Care providers were seeking a way to stabilize revenues, fund improvements in patient care and establish a platform to respond to potential State moves in managed Medicaid. Clear View Solutions conducted the feasibility studies and concluded that the target markets would support a Medicare managed care program. We developed the organizational structure and financing. The low income and highly rural nature of the market indicated that a Dual Eligible Special Needs Plan would address the target population. Throughout the application and approval process Clear View consultants worked with the client to recruit networks, compile documentation and address State and Federal concerns. This program is now operational in over 30 counties in the state.
Institutional Special Needs Plan
Innovation and market leading products characterize the corporate persona of this multi-state organization. Establishing a Medicare Advantage Plan is part of a strategy to address care transitions and quality. While participating in the CMS Post-Acute Care Bundled Payment demonstration, this organization wants more. Clear View Solutions conducted a feasibility study in the selected markets and concluded that with adequate care coordination the program could succeed. We recruited thousands of providers and marquee health care systems to meet the rigorous network adequacy standards of CMS. At the same time, we provided expertise and assistance to this new organization. Result? Comprehensive applications, initially in two states, expanding to another two in subsequent years, including State Insurance licenses, contracted networks, administrative framework and contracted vendors.
Multi-State Medicare Advantage HMO and PPO
A national life and health insurance carrier made the strategic decision to enter the Medicare Advantage market. Clear View Solutions conducted a national study to determine which areas would be most receptive to the client’s programs and financial objectives. Subsequently we assisted the organization to prepare applications in multiple states across the country. We contracted provider networks for both HMO and PPO programs, identified vendors to support administrative services, recruited staff, supplied comprehensive implementation assistance including policies, procedures and sample materials. With both acquisitions as well as new markets, this organization is poised to launch in over a half dozen states and markets.
Health Plan organizational improvement
Clear View Solutions works with existing health plans to improve operations, identify new markets and design benefits and care coordination programs that enhance member growth and profitability.
For instance, imagine that you have launched a new plan in a new market and you are uncertain about the risk profile of the population that chooses your product. How do you quickly gain an understanding of your membership? You might try a multivariate analysis of their pharmacy consumption. Partnering with another consulting organization, we generated a profile of their member population months before it would have otherwise been available and enabled the client to identify gaps in care and diagnosis coding opportunities.
Clear View Solutions worked with a post-acute care company to develop PACE organizations. We identified high potential markets, completed feasibility studies, enrollment projections, pro formas for State and Federal applications, policies and procedures required by State and Federal regulators and have filed complete CMS applications. Our team helped the client contract provider networks and assist in program launch.
Buying a plan or company is challenging. It is especially challenging if you are a provider delivery system that does not have the licensure or infrastructure to support the purchase. Clear View has worked with both the selling and buying organizations to ensure that a smooth transition occurs. Administrative solutions are identified, either in the vendor community or through partnership arrangements. Strategic, financial and regulatory consulting assistance makes sure that all goes well. Enrollment is up and administrative disruption is minimized. It is yet another validating example of how Clear View targets resources and talents across organizations and vendors to serve similar populations.