Healthcare consultants for hospitals, managed care organizations, government, law firms, labor unions, major employers, purchasers, providers and consumers.
 

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847-868-8648; 847-266-7800

 

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Healthcare Consultants, healthcare consultants, healthcare benefits consultants, employee benefits consultants, health care consultants, Health Care Consultants, Managed Care Consultants, Litigation Support, Legal Consultants, litigation support consultants, Benefits Consultants, Medicare consultants, Medicaid consultants, Healthcare consumers, Healthcare purchasers, Executive search, malpractice, healthcare policy, healthcare public policy, workers' compensation, MediCal, corporate healthcare, government healthcare

Representative Client Engagements and HCI Expertise


Oregon

Fraud, Unmonitored Service Vendors Characterize Health Plans

A city government with almost 27,000 healthcare plan beneficiaries had been paying provider bills through its TPA, which among other problems, failed to monitor submitted claims properly and received kickbacks from the PBM on a per RX basis. The MCO was raising premiums double digits annually and would not disclose critical cost and provider contract information to our client. It was apparent that relationships among the various service vendors were so rife with conflicts-of-interest that controlling costs and monitoring the quality of services were secondary considerations.

HCI provided our client with more than 50 substantive recommendations for changing the infrastructure of its healthcare benefits plan and ensuring optimum control and accountability. Realistic savings will accrue in the 18-21% range of its healthcare expenditures, which exceed $50 million annually.

 

Rising Employee Benefits Costs and Low Morale


A national communications company with 4,000 employees was experiencing rapid annual increases in health care benefits costs. All of the traditional methods of suppressing costs had been implemented. The labor unions, which represented over 80% of their hourly employees, were threatening a strike over the increases in costs and reduction in benefits of the health care plans. Labor-management tensions mounted and employee morale and productivity were severely strained.

HCI designed and implemented an Employee-Employer Partnership®, which provided our client and their employees with the vehicle for changing to a more rational, cost-effective and qualitative self-insured health care plan. An on-site primary care clinic and Micro-PPO specialty care delivery system were created for our client. Within one year, health care benefits costs were reduced 23%. Employees were provided with easy access to objective, state-of-the-art medical information on demand. Incentives were created to reward beneficiaries who utilized the highest quality health care providers in the region.



Long-Term Care Insurance Company Denies Legitimate Claims

HCI was contacted by the daughter of a Senior, who required home care aide assistance following hospital discharge and sub-acute nursing home care. She was insured by a national company, which arbitrarily decided to deny reimbursement for her care. After reviewing the long-term coverage policy, which was in force for more than a decade, HCI provided the impetus for the insurance company to reverse its denial and pay the claims retroactively and going forward.

 

Government Health Care Program for Medically Indigent Population is Improved


A Midwestern County government was mandated to fund health care for a medically indigent population of 20,000 people. Poor eligibility verification, a non-competitive preferred provider network, ill-conceived utilization review practices, and several other deficiencies caused the program to have a budget deficit of over $11 million.

HCI designed and implemented cost control mechanisms which closed loopholes and established an efficient and high quality managed care system. Per case contracts for hospitals and physician providers were designed and successfully negotiated. Capitation contracts for 73 other health care providers were implemented. A new system for processing and monitoring claims was designed and implemented; we retained a Third Party Administrator to operate it. Within the first 11 months, our client saved $10 million and reduced patient complaints by 34% because both preventive care and the quality of care had been improved. Preventive care, previously given short shrift, became the top priority.



The Medicare Enrollee's Annual Challenge

HCI was contacted by the family of a Senior, who had enrolled in Medicare several years ago. They asked us to provide them with an analysis of current Medicare plan options: Medicare, Medicare Advantage, Medicare Part D Prescription Programs, and Medicare Supplemental Plans (aka MediGap) offered in the client's zip code area.

Our analysis revealed that the client could save at least $3500 annually by making other choices among the myriad of options, especially his Medicare Part D and Supplemental plans. This client realized a significant cost savings and much greater freedom-of-choice in his selection of healthcare providers.

 

Three Employers: A Common Hemorrhage is Stopped


Three employers with a common Third Party Administrator and a combined 19,300 covered lives believed that certain health care providers were billing for excessive care in specific specialty areas on a consistent basis.

HCI organized a network of physicians with the most successful medical outcomes and hospitals with the best quality indicators. We designed a per case payment formula. Our clients were able to realize $3.1 million in savings and an 18% reduction in the mortality rate for their employees and dependents within two years.



Plaintiff's Lawyers Obtain Assistance to Pursue Litigation

A wrongful death lawsuit was filed against a hospital. The case involved a young man who sustained injuries in an industrial accident.

HCI was retained to evaluate the evidence and to assist in discovery. We found that the facility was seriously understaffed and inexperienced physicians and nursing staff had treated the patient in the first critical hours following his injuries. Several personnel attempted to cover-up the incident and failed to report significant details to hospital administration. An out-of-court settlement was reached and several hospital staff were terminated.



Creating Change in Rural Health Care


A major employer in a rural area was totally dependent upon one hospital for most health care services for employees and their dependents. Excessive utilization was evident in all but two diagnostic areas. Our client was experiencing excessive costs of $4 million annually.

HCI established a Consumer Information System, hired a vendor to staff and administer a primary care clinic, and created a targeted specialty care Micro-PPO which included physicians from the nearest large city. Our client has experienced an average of 28.6% savings from the base year's healthcare costs over the initial 4 years of these changes.

Oregon Tort Reform 2004 ---

Capping Liability Damages, Punishing Consumers

The Oregon Trial Lawyers retained HCI to help defeat Ballot Measure 35, which would have amended the constitution to establish a $500,000 cap on non-economic damages in medical liability cases. The ballot measure lost by 50.53% to 49.47%. The failed effort to pass the ballot measure was funded by healthcare providers within and outside of Oregon. HCI has long been committed to enhancing quality of care and patient safety as the solution to curbing preventable plaintiffs' injuries, deaths, and subsequent litigation. Our independent analysis of medical malpractice insurance premium increases links them to cyclical and erratic investment returns and poor portfolio management, not frivolous lawsuits.

HCI's role in the successful effort to preserve unconstrained patients' jury awards was to provide consultation, information, and research input to trial lawyers campaign management.



Excessive Mental Health Care Costs


A Northeast services company was experiencing high costs for mental health care and out-patient primary care services. Somatizing and chronically ill patients were driving these costs.

HCI developed a customized managed mental health care program linked to primary care networks and the Employee Assistance Program. Our client reduced mental health care costs by 32% and overall health care costs by 17.5%.

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Healthcare consultants for hospitals, managed care organizations, government, law firms, labor unions, major employers, purchasers, providers and consumers.

HealthCare Initiatives, Inc.

  847-266-7800; 847-868-8648 

HCI@healthcare-consulting.com


© 1998-2017 HealthCare Initiatives, Inc.