Based on the findings and recommendations developed from the opportunities assessment, we will prepare a comprehensive set of benefit design, care management initiative development and health benefit delivery entity selection strategies. These strategies focus on achieving quick results and encompass related initiatives such as optimizing benefit plan designs, providing tools for optimal selection of carrier and care management vendors, providing recommendations as to remedying of problematic care management and provider network management and contractual practices undertaken by the client's health plans, MCO's and vendors, and contractual elements, levels of care, review process participation, and enhancing bottom-line profitability.
This Strategy forms the basis of a detailed implementation plan that identifies development priorities and assigns accountabilities and deadlines. The vehicle that is critical to ensuring the success of the program is the identification of individuals from within the customer and supplying organizations that are charged with forming a care management action committee. Key participants from the corporate side include Finance, Human Resource and Benefit Management executives. From the supplier side, care management level decision-makers whose crucial functional areas include finance and reimbursement, medical management, care management operations, provider contract management,, appeals and quality management are key to this process. CAI will work with your senior management team to identify the appropriate members of this committee.
This Committee will be responsible for the following:
- Critical review and synthesis of the CAI report on the comprehensive assessment and the accompanying recommendations
- Setting of an overall care management strategy that aligns with the employer's initiatives
- Manage the development of the detailed implementation plan
- Define the implementation priorities for implementation of recommended changes
As a catalyst that ensures successful formation and ongoing activities, CAI will be instrumental in:
- Developing meeting agendas
- Facilitating productive outcomes of the planning sessions
- Providing succinct reports to health plan senior management regarding progress made relative to the initial plan of goals and objectives.
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