Managed Care
Related Services
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Managed Care Dashboard and Performance Report Development
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Determination of types of executive dashboards required and/or recommended
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Membership and Enrollment
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Member/Patient Demographics
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Access to Care and Capacity
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Inpatient Utilization
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Outpatient and Ancillary Utilization
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Financial (Profitability)
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Patient Experience
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Key performance measures and drilldowns
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Assessment of available data sources and systems
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Decision on new data to be collected
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Mapping of data sources and fields
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Construction of dashboards
2. Eligibility and Capitation Reconciliation
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Outline process for the routine and monthly reconciliation of eligibility and capitation files from health plans
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Develop procedures for incentive and risk pool reconciliation
3. Capitation and Fee-for-Service Rate Review
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Review of approach, development and assumptions including, but not limited to, examination of capitation rate tables, assessment of process and considerations and project plan for construction of rates, pools, carve-outs, and incentives, as applicable.
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Recommendations on proposed rates and/or rate ranges including adequacy (applicable base data adjustments, managed care adjustments, claims cost trends, and risk adjustments for current and subsequent periods covered) and/or soundness (capitation rates and other revenue sources provide for all reasonable, appropriate and attainable costs).
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Review of rates paid for provided and/or purchased medical services.
4. Meetings and Conferences
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Participate in planning committee meetings and/or project planning sessions.
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Meet with administrative, clinical and/or operational staff.
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Meet with executive project owner and/or project manager on regular basis.
5. Written Reports and Recommendations
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Provide periodic status reports to executive project owner/sponsor.
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Prepare and present written recommendations on managed care infrastructure.
6. Knowledge Exchange
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Provide information and expertise on managed care infrastructure to key stakeholders.