Partnering with Health Plans to Drive Positive & Sustainable Outcomes
Facing today’s complex and challenging environment requires a partner who you can trust to provide clear and objective approaches for achieving your goals. A&M works alongside our health plan and managed care clients to efficiently deliver lasting value that continues to be realized long after an engagement ends.
We have been in your shoes – we understand the wide array of stakeholders you answer to including members, patients, boards, shareholders, and the broader community. Many of our seasoned professionals are former healthcare executives with proven track records for delivering durable results with a focus on accountability.
Unlike traditional consulting firms, A&M is with you from inception through execution, collaborating with you to implement pragmatic, data-driven recommendations. We draw upon a deep operational heritage and take a hands-on approach to achieve measurable success.
We can help with:
- Product & Market Growth Strategy
- Corporate Development
- Consumer Engagement & Digital Health
- Financial Operations
- Transaction Advisory
- Financial & Operational Due Diligence
- Medicare Advantage & Government Program Management
- Pharmacy Benefit Management
- BPO Optimization
| - Value-Based Arrangements
- Network Integration & Provider Contracting
- Vendor Management
- Cost Optimization for Medical & Operational Expense
- Government Regulations & Compliance
- Care Management Operations
- Technology Operations
- Program Claims & Audit
- Risk Adjustment and Revenue Management
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We assist various health plans and managed care organizations, including:
- Managed Care Companies
- Government Plans
- Government Healthcare Organizations
- Commercial Health Plans
- Pharmacy Benefit Managers
- Third Party Administrators
| - Integrated Health Systems
- Accountable Care Organizations
- Managed Long Term Care Organizations
- Telemedicine & Virtual Care Companies
- Payer Service Organizations
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As we approach 2025, U.S. health plans across are facing growing pressures stemming from a mix of economic challenges, regulatory complexities and rising consumer expectations. These issues are threatening the financial sustainability of health insurers, impacting the quality of care they can provide, and the overall health outcomes for their members.
Provider-Owned and Provider-Sponsored Health Plans (PSHPs) offer a unique opportunity to improve care delivery while maintaining control over both the insurance and care provision components of the healthcare system. These plans are increasingly seen as a solution to the challenges facing traditional health insurers, offering the potential for improved care coordination and cost management.
Home-based healthcare can deliver better outcomes, at lower cost, and with a better patient experience. Technology exists to enable the most sophisticated solutions, yet, post-pandemic adoption of virtual services, including hospital at home and many consults, has waned.
Medicaid redeterminations have moved more than 24 million people off state Medicaid rolls in less than 18 months. While the disenrolled are the most obviously impacted group by this sudden drop, the remaining enrollees and the companies that insure them will also experience the squeeze that comes from a riskier population and a smaller pool of resources.
