Guidehouse Commercial Payer

Commercial Payers

Commercial Payers

Performance Improvement Services

Guidehouse's healthcare performance improvement services consultants assist payer clients in facing various challenges by designing, launching, and leading organizational transformations with the goal of creating a high-performance culture resulting in market success.

Payer organizations face challenges that require the need to drive continuous cost-optimization through Medical Loss Ratio (MLR) and Administrative Loss Ratio (ALR) improvements, financial and clinical enhancements through quality ratings and risk-adjustment programs, and regulatory compliance through several prospective and retrospective measures. To compete and succeed in the future of healthcare, payer organizations must continue to pursue these measures while focusing on the quality of member interactions with the healthcare system.

  • MLR Reduction
    • Leverage deep clinical expertise to design clinical programs to target MLR opportunity across different business lines
  • Quality Ratings
    • Identify and prioritize Stars improvement opportunity through the design and deployment of Stars and Stars-related programs
  • Compliance Issues
    • Assess CAHPS measures, help with remediation, perform audits 
  • Risk Adjustment
    • Develop risk adjustment program and processes; create analytic suite of reports to best support your organizations HCC optimization efforts

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