Strategic Consulting

HCIM’s Strategic Consulting Team can help you optimize the three pillars of the new Healthcare Payer Model – Medical Expense, Appropriate Revenue, and Administrative Expense, while building on the foundation of quality focus, process improvement, and technology efficiency. HCIM’s team of experienced Healthcare Executives partner with payer organizations and provider groups to establish a vision, architect a transformational blueprint, and execute through to a successful completion. Our collaborative approach ensures that all areas of the organization work together smoothly and efficiently through creatively applied technology, process redesign, and innovative problem solving. Contact us today to learn how our experts can transform your organization through the following specialties:

The New Healthcare Payer Model - HCIM's 3 Pillars

Medical Expense

Network Management
  • Process Improvement
  • Provider Contract Modeling
  • ACO-PLHP Network Design & Implementation
  • Risk-Based Contracting (Capitation, Risk Pools, Bundled Payments)
  • Value-Based Reimbursements (APMs, MACRA, MIPS)
Population Health Management
  • Utilization Management (UM Authorizations, Referrals, Pre-Certs)
  • Medical Management Optimization
  • Care Management (DCM System Implementation)
  • Performance & Quality Measures
  • Medical Loss Analysis & Recovery
  • Population Analysis
Physician & Care Team Engagement
  • EHR System Implementation & Optimization
  • Data Driven Personalized Healthcare
  • Advanced Care Models (Special Needs, SNPs)
  • Research & Education Support
  • Medical Center Operations

Appropriate Revenue

Industry & Regulatory Compliance
  • HEDIS Measures
  • Affordable Care Act (ACA)
  • Health Insurance Exchange (HIX)
  • Operating Rules
  • HIPAA & HITECH
Premium/Risk Adjustments
  • Hierarchical Condition Codes (HCCs)
  • Health Insurance Exchange (HIX)
  • Stars Rating Improvement
Reconciliation
  • Membership Reconciliation
  • Coordination of Benefits Contractor (COBC) Requirements
Broker Commissions
  • Tracking
  • Reporting
  • Payments

Administrative Expense

Operational Improvements
  • Cost Reduction Strategy Development (Outsourcing – BPO, ITO)
  • Disaster Recovery & Contingency Planning
  • Interim Executive & Director Level Resources
  • Executive & Subject Matter Expert (SME) Placement
Healthcare Analytics
  • Data Analysis & Interpretation
  • Analytics Partner Selection
Business Model Restructuring
  • Strategic Systems Decision Analysis
  • Business Transformation Plan Development
  • MSO Development
Systems Implementation
  • Health Insurance Exchange
Claims Management
  • Claims System Administration
  • Pre and Post Payment Claims Audits

Contact Us

For more information, call 925-265-4113, option 5 or complete the form below.

Meet our Team

HCIM Selected as Top 20 Healthcare Consulting Provider by CIOReviewHCIM awarded CIOReview's 2015 Top 50 Healthcare Solution Provider