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Medicare
Driving excellence in Medicare across the healthcare value chain
We draw on extensive industry knowledge, a deep pool of experts, and decades of service to the healthcare sector to support clients across the value chain and provide distinctive insights. Our teams collaborate with payers, provider systems, PBMs/pharmacies, private equity, third party solution vendors, and regulatory bodies to meet the challenges of an increasingly complex healthcare landscape.

What we do

Local market analysis

We use census-tract and county-level analytics and Medicare Advantage–enrollment projections to determine growth opportunities for our clients. Using advanced analytics, we help inform competitive-product portfolios and marketing strategies to support organizations.

Product portfolio and benefit design

We drive end-to-end design (or redesign) of product portfolios using both publicly available Centers for Medicare & Medicaid (CMS) data and client-claims data—our actuaries work hand in hand with client teams to develop actuarially sound product designs. We also help clients refine their portfolios via consumer research and simulations.

Member-centric engagement

We drive growth across enrollment sources by deploying next-generation engagement strategies, including proprietary analytics to prioritize outreach and develop customized journeys based on consumer microsegments and member-level preferences. We also support clients on building commercial-partnership strategies to improve age-in conversion.

Marketing and sales excellence

We perform rapid diagnostics and benchmarking across marketing and sales to identify opportunities to improve conversion and cost effectiveness, deploy channel-level strategies to segment and prioritize brokers, improve internal-agent performance, optimize digital marketing and engagement, and build capabilities for continuous improvement.

Risk-coding improvement

We provide end-to-end support to improve risk-coding accuracy and completeness for Medicare Advantage payers and, ultimately, to improve patient care through better clinical documentation.

Star-rating and quality-program optimization

Offering seniors ever-improving quality-of-care and health outcomes is an imperative for Medicare Advantage payers. We deploy our proprietary Star-rating-performance diagnostic to identify priority measures and highest return-on-investment (ROI) interventions for near-term impact and resource optimization. We also work in partnership with clients to support the execution of initiatives to improve program governance and interventions using advanced analytics.

<40

Medicare-growth projects

in the past 2 years across the healthcare value chain

15–20%

revenue improvement

20–25%

growth

Featured capabilities

We invest heavily in developing ready-to-deploy proprietary tools, databases, and methods.

County-level profitability assessment: Our actuarial analytics use CMS benchmarks, competitor-performance metrics, and local disease burdens to determine the ability to achieve success with specific products at the county level.

Medicare Growth Model: We use a proprietary advanced-analytics model to predict growth of Medicare Advantage, Medicare Supplement, Medicare Part D, and traditional fee-for-service programs at the county level.

Member Lifetime Value Model: We use a tool that calculates the lifetime value of an existing or potential Medicare Advantage member using claims data, demographic data, and risk-coding history, to help in the implementation of specific interventions to improve retention and attraction rates.

Lead-scoring analytics: Our comprehensive suite of predictive analytics, including likelihood to buy, likelihood to churn, and likelihood to convert, scores leads based on conversion opportunity.

Best-fit product matching: We use advanced analytics to determine a member’s optimal Medicare product based on various inputs including past utilization, third party consumer data, and past interactions, to optimize member experience and satisfaction with their coverage, hence improving conversion and retention.

Telesales-agent-optimization tool: Our interactive platform provides agents with a best-fit product match and customized member-level value propositions, interaction history, and utilization insights to enable a positive and seamless sales experience for members. 

Risk adjustment: Our proprietary advanced-analytics suite identifies gaps in coding and evaluates performance by line of business, market, vendor, and provider. This comprehensive performance teardown, along with our proprietary database of industry benchmarks for supplemental-program performance, enables us to assess the opportunity at a granular level to improve intervention-strategy design for clients.

Stars Performance Diagnostic: We use a comprehensive diagnostic tool to prioritize metrics and identify the highest ROI interventions to achieve high quality ratings across member experience and clinical outcomes measures. By achieving and retaining 4-star ratings and higher, payers are able to offer more competitive products to meet member needs.

Examples of our work

Age-in-conversion optimization

A large regional payer had a low age-in-conversion rate. We helped design and implement an age-in-conversion strategy across marketing and sales channels, improving the age-in conversion by three times and driving 20 percent improvement in agent productivity using best-fit product-matching analytics.

Star-rating improvement

A not-for-profit plan across multiple states with a poor Star performance on Medicare Advantage plans sought our help in developing a rapid assessment of the program to improve performance. We worked hand in hand with the central Star organization to implement a defined set of initiatives and helped the client achieve a 6 percent gain in revenue over two years, with a revamped budget and governance model to sustain success year over year.

Medicare-growth strategy

A large health plan embarking on a huge program to transform its growth sought our support in identifying the biggest value-creation opportunities and strengthening nascent capabilities. We developed an 18-month Medicare-growth transformation and helped the client build a full, end-to-end, digital product-match personalization tool, leading to higher conversion rates and an increase in members.

Featured insights

Article

The evolution of healthcare-provider profit pools

– Why nonhospital-provider segments are primed for growth—and why that matters.
Article

Assessing the Medicare Advantage Star Ratings

– Since Star Ratings were introduced a decade ago, average MA plan performance has improved, quality standards have risen, and more... people are enrolled in higher-quality plans.

Connect with our Healthcare Systems & Services Practice