| Healthcare Consulting
As the managed healthcare environment continues to rapidly change, organizations must be prepared to continually examine traditional business practices. (NHA) will work as your partner to develop strategies and tactics tailored to your specific organizational needs to develop a successful and rewarding environment. NHA will work with your organization to identify and maximize your organization’s strengths and design new opportunities that are customized to your organization’s vision while maintaining your core business philosophy and culture.
Our services include:
Provider Network Development for Expansion
NHA understands the importance of creating and maintaining quality networks through carefully developed reimbursement and incentive programs. These networks must consist of experienced, qualified physicians who are proficient in practicing quality healthcare in a managed care environment. NHA’s network development projects have included both local and regional, as well as national projects. NHA staff has experience in developing these networks under different compensation structures, including capitation, fee schedules, discount arrangements or a percent of premium basis. NHA will work with your organization to develop and maintain reimbursement and incentive programs to ensure participation of the appropriate providers. NHA will perform all credential activity to ensure each of the recruited physicians will meet NCQA standards. NHA also can perform on-site office orientations, as well as site surveys.
Strategic Planning
NHA will work with an organization to review their existing organizational structure and capabilities to identify strengths of the organization, and how to capitalize on those strengths. We will also help identify weaknesses, if any, and work with management to overcome those weaknesses. NHA will develop a vision for the organization that represents the organization’s mission, culture and philosophies utilizing the organization’s resources.
Contract Review/Preparation/Negotiation
NHA will assist your organization in reviewing managed care contracts to ensure your organization is adequately protected and can operate profitably within the guidelines. NHA will ensure members of your organization have a clear understanding of the contract and that internal procedures and policies are established in adherence to the contracts. (*Due to our having both created and reviewed an extensive volume of contracts.) NHA can create a contract for your organization that ensures adequate protection for your organization, NHA can assist your organization in the negotiation process, following your guidelines, policies and vision to the point where we will secure a finalized draft for your review.
Reimbursement Analysis/Incentive Programs
NHA will complete a detailed reimbursement analysis to assist your organization in properly evaluating the financial impact of reimbursement terms. We will also work with your organization to ensure everyone in the organization completely understands the terms of the contract and the reimbursement to assist with successful management of the contract.
Capitation Contracting
NHA will work with your organization to develop an understanding of all aspects of capitation contracting. This enables your organization to successfully manage your operations under a capitated environment. NHA can assist in negotiation of a capitated arrangement or can actively work under your direction to create a capitated contract.
Product or Market Development and Initiatives
When your organization is adding new lines of business or entering into new markets, this requires extensive planning and product management. NHA can assist your organization in developing these new lines of business and can provide oversight of the individual process steps. NHA can also provide assistance with everything from project management through implementation of new products or markets. These managed care products would include HMO, PPO, Point of Service, Administrative Services (primarily for self-funded), and Risk Arrangements (such as Medicare) that are designed to increase managed care market penetration.
Development of Various Integrated Delivery Systems
NHA can assist in the development and implementation of various delivery systems such as Physician Hospital Organizations, IPA’s and Integrated Networks. NHA can also create an alternative delivery system to meet your specific market or needs. Our services would range from design, contract review/negotiation to actual startup of operations.
Medical/Quality Management Programs
A successful managed care program requires effective medical management and quality management programs. NHA will assist in the development of these programs and ensure that the programs are maintained to guarantee quality and cost effectiveness of medical care.
Organizational Design/Operations Management
The healthcare field is growing and continually changing at a rapid pace, which can place added stress on an organization. NHA will assist your organization in the development and implementation of new organizational structures or assist in the transition from an existing structure to a new organizational structure. Our experience with risk sharing arrangements, various information systems, claims administration, member services, provider relations and medical management enable us to provide assistance to your organization during these stressful times.
Collateral Development
NHA can assist your organization in creating new benefit plan designs and drafting member materials such as enrollment brochures, applications and member handbooks. NHA can assist in the development of provider contracts, provider manuals and provider directories. In addition, NHA can assist your organization in creating programs for member services and for provider relations. We can provide input to aid your organization in the design of materials distinguishing your product or service from others in your market.
Market Studies
When creating new products or entering into new markets, NHA will conduct a market study outlining the feasibility of the new line of products or entering into the new market. In addition, NHA will prepare a business plan outlining the key tasks necessary to effectively proceed.
Staff Training
To ensure all new and current employees are properly trained, NHA will work with your organization to create a customized training program focusing on the various aspects of managed care, such as the differences between HMO, PPO and POS products, how they compare to the traditional fee-for-service environment and how co-payments and deductibles are applicable to any of these types of programs. In addition, training programs can be designed to ensure all staff properly and effectively perform their functions under the existing contractual relationships.
Employee Benefits
NHA has extensive knowledge in the field of employee benefits, with experience and a strong understanding of the internal workings of Managed Care Organizations. NHA can provide valuable assistance in developing new employee benefit packages, on reviewing existing employee benefit packages to ensure that cost control measures are in place, while at the same time, preserving the quality of care provided to employees.
Implementation of New Plans
NHA will assist your organization when implementing a new healthcare plan or offering additional healthcare options. NHA has experience conducting employee meetings, ensuring all materials are distributed to employees on a timely basis, and educating your employees so they understand their benefits and their options. NHA will also act as your liaison with the health care plan to ensure new plans are implemented successfully and operate smoothly.
Request for Proposals
NHA will assist your organization in creating RFP’s, whether selecting a health insurance carrier, provider network or third party administrator. NHA will also assist your organization in responding to an RFP when you are requested to complete an RFP to provide your services.
Employee Contribution Analysis
NHA will analyze and audit employee contributions for union or corporate health funds. NHA can also assist you in reconciling past contributions and verifying receipt of such contributions. NHA can consult with your organization to project future employee contributions.
|
