Payors

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Healthcare payors are being challenged like never before. Rapid consolidation resulting in mega-insurers and Affordable Care Act mandates and initiatives are stretching capacity to adapt among even the most agile insurers. Building market share across plan designs, scaling up to ensure cost-effective operations, and managing population health initiatives are just a few of the most pressing issues keeping payor leadership awake at night.

ECG advises traditional and provider-owned insurance companies across the spectrum, including Medicare Advantage and Prescription Drug Programs, Medicaid Managed Care, commercial insurance, and third party administrator services. Whether it’s strategic planning, technology procurement, financial and operational turnaround, product design, or data management, we have a team with multidisciplinary payor expertise ready to provide support to your organization.

Our payor services are positioned to address your full spectrum of needs:

STRATEGY:FINANCE:
  • Strategic Planning
  • Exchange, Medicaid, Medicare Advantage and Commercial Product Planning and Strategic Advisory Services
  • Product Design, Development, and Marketing
  • Membership Retention Strategy and Implementation
  • Provider Joint Ventures
  • Premium Pricing Strategies
  • Risk Review, Adjustments and Recovery
  • Financial Operations, Budgeting and Reporting
  • Provider Reimbursement Design and Funds Flow
  • Payment Innovation
OPERATIONS:TECHNOLOGY:
  • Turnaround Services
  • Medical and Utilization Management Program Assessment, Structure and Optimization
  • Business Process Assessment, Design and Optimization
  • Network Development and Contracting
  • Member and Provider Communications and Outreach
  • IT Strategy and Data Architecture
  • Population Health Management Processes and Support
  • Data Management Plans, Data Warehousing, Business Intelligence/Decision Support
  • Technology Procurement – Claims Processing Systems, Communication Systems, Operational Applications