Health Plans and Managed Care

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

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

Payers Have an Opportunity to Expand Value in Home-Based Health

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 – The Unintended Consequences

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.