A consulting firm supporting payer organizations struggled to differentiate itself in a competitive landscape. Limited understanding of CMS’s Health Equity Index (HEI) metrics and an absence of robust tools for optimizing payer-provider (payvider) models constrained the consultancy’s ability to address key client needs. Without these capabilities, the firm was unable to position itself as a trusted partner in improving Star Ratings and advancing health equity.
To address challenges in achieving differentiation and delivering value for health plans, Akros Advisory developed a tailored approach to empower the consultancy with innovative tools and strategies.
Grounded in deep industry expertise, our work focused on four critical areas:
Strategic Assessment of HEI and Payvider Challenges
We began by evaluating the consultancy’s existing capabilities and alignment with evolving payer priorities:
A limited understanding of CMS’s Health Equity Index (HEI) metrics restricted the consultancy’s ability to help payers meet compliance benchmarks.
The absence of tools for optimizing payvider (payer-provider hybrid) models hindered the ability to address care delivery inefficiencies and improve member outcomes.
This analysis underscored the need for solutions that integrated HEI metrics and supported the unique dynamics of payer-provider collaborations.
Development of an HEI-Focused Playbook
To address gaps in HEI knowledge and implementation, we created a comprehensive playbook to guide clients through HEI compliance and optimization:
HEI Integration into Workflows: Designed processes for embedding HEI metrics into existing payer workflows, ensuring alignment with Star Ratings measures and CMS requirements.
Data-Driven Insights: Provided a framework for leveraging SDOH and demographic data to prioritize health equity interventions, helping payers identify high-impact areas for improvement.
Strategic Guidance: Offered step-by-step recommendations for achieving HEI benchmarks, including predictive modeling to assess the impact of targeted interventions on Star Ratings and quality bonus payments.
This playbook served as a roadmap for payers to navigate the transition from the Reward Factor model to HEI-based Star Ratings.
Introduction of a Payvider Optimization Matrix
Recognizing the growing importance of payvider models, we developed a matrix to enhance care delivery at the intersection of payers and providers:
Model Design and Analysis: Created tools to evaluate and optimize care delivery models, focusing on reducing inefficiencies and improving member outcomes.
Alignment with Value-Based Care: Provided strategies to integrate value-based care principles, aligning payer and provider incentives to drive cost savings and quality improvements.
Actionable Recommendations: Delivered insights on implementing targeted interventions for high-risk populations, leveraging predictive analytics to identify opportunities for care coordination and cost containment.
Client Feedback
“Akros Advisory’s expertise in health equity and payvider dynamics has revolutionized our client offerings. The HEI playbook and optimization tools have allowed us to deliver unparalleled value, helping our clients achieve compliance and drive meaningful improvements.”
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