We’ve been doing Medicaid Risk Adjustment since the ‘90s. Few people in the industry have that kind of institutional know-how.
Does your consulting firm or business process outsourcer have a client or a prospective client with a vexing pain point? Or are you confronted with an innovative plan/issuer that knows what they want but isn’t clear on how to get there? For example, bundled payment program designs can be complicated—historical data needs to be trended and adjusted for the unique aspect of the alternative payment arrangement. Member and provider outreach programs have to be driven by meaningful, practical analytics, not just a plan to make plenty of telephone calls. And all interventions need to be evaluated after implementation, to be sure they are working and delivering value consistent with the expenditures.
Perhaps the client needs a Medicaid or Marketplace suspect list for revenue management or they are trying to measure quality consistent with their state’s particular requirements? Or they need a data governance assessment because they can’t improve their quality ratings or risk scores? Is the client’s “data lake” incomplete? Are they interested in multivariate statistical modeling to test interventions? These are just some of the ways that Mile High Healthcare Consulting can support the client of business process outsourcers or vendors. We know data, we know statistics, and we know how quality improvement, risk adjustment, and value-based payment initiatives are supposed to operate.
Mile High’s particular skill is to support Medicaid and Marketplace analytics. Although we have been designing and disseminating Medicare-Advantage tools for over a decade, we rely on the 20 years of experience with Medicaid and commercial risk adjustment to support vendors and plans who are migrating away from Medicare-Advantage.
Mile High Healthcare Consulting can serve as your subcontractor or we can discreetly provide advice to your staff without directly interfacing with your client. Our software tools can be deployed on a white label basis or our IP or software can be the “Intel-Inside®” adding credibility to tools you have built yourself.
Because we understand data and manipulate it ourselves, Mile High ensures the validity of the results from analytics and the applicability of those results to our clients’ objectives.
Our team brings decades of experience in performing, applying, and interpreting predictive analytics. We are able to write algorithms and code to traverse very large data sets and synthesizing findings into practical recommendations. We have extensive experience in application development, data warehouse design, and business intelligence development, enabling us to create back-end technology solutions that enable ongoing client analytics.
We have performed hundreds of projects supporting clients with data governance, data management, NCQA HEDIS certification and quality measure calculations, CMS Star ratings improvement plans, PQA technical specifications as well as risk adjustment and suspect analysis and have a high level of understanding of both the underlying data and the predictive modeling for healthcare optimization.