Health Plans
Why Work with Us
Position for Success
Health plans should match their strategy with data to meet the needs of their patients better.
Our team of health plan experts combines first-hand industry experience, unique policy perspective, and access to unmatched data and analytics capabilities. Count on us to help you evaluate and manage risk, determine and optimize provider partnerships, expand into new business lines and markets, and prepare for future changes that will impact your business.
Improve Financial Performance
Thoroughly evaluating your risk and quality performance, we perform third-party, end-to-end assessment encounter data system (EDS) submission to identify opportunities to improve your risk score accuracy. We also identify and improve factors that cause low Stars performance, including supporting the appeals process.
Optimize Provider Networks
Gain transparency into provider performance in new markets and within your existing network. Our access to Inovalon’s MORE2 Registry® gives us commercial, Managed Medicaid, and Medicare Advantage data. Analyzing this unique data from the lens of our government program and value-based provider arrangement expertise, we can optimize your provider network for growth and profitability.
Achieve Program Compliance & Operational Effectiveness
Transform operations while maintaining program compliance with our deep policy expertise and hands-on evaluation of your operational capabilities and gaps. Confidently expand into new markets and lines of business, considering the most important drivers of compliance and profitability.
Define Strategic Priorities
Develop a practical strategy with our highly collaborative approach facilitating leadership retreats and cross-functional work groups to understand the impacts. We work closely with every stakeholder to identify realistic steps and get you from here to there.
Health Plan Capabilities
Our Experts
Senior Consultant, Evidence & Strategy
Michael Lutz supports clients who serve members of Medicare, Medicaid, and commercial health programs. He applies his background in plan operations and strategy to help customers anticipate and implement changes in federal and state regulations to ensure program compliance and operational efficiency.
Principal, Policy
Robin Duddy-Tenbrunsel provides policy analysis and strategic advice to stakeholders across the healthcare continuum, with focuses on Medicare Advantage and social determinants of health.
Managing Director, Policy
Sean Creighton serves in Avalere’s Policy practice, focusing on Medicare Advantage (MA) and Part D reform, risk adjustment, and analysis of healthcare quality and utilization.
