Health Plans & Insurance
Innovate care while managing costs and compliance with our health plan solutions
Health Plans & Insurance
Today’s healthcare market is rapidly changing, so you need a different kind of business advisor. One that understands the healthcare industry, your business, the unique challenges to your specific organization and the interrelated nature of many of these challenges. Baker Tilly’s health plans and insurance professionals can help.
Top trends for health plans
Network management
Customers and program sponsors demand better quality and more cost-effective healthcare. As such, health plans must strategically adopt and scale networks while evolving the way they collaborate with internal and external stakeholders (e.g., healthcare providers, consumers and regulators). Network management strategies including comprehensive data management, proactive regulatory compliance, integration of risk management functions, early and ongoing engagement of internal audit, digital transformation and advancing value-based care programs are key to successful network optimization.
Baker Tilly’s health plan solutions can help create effective and compliant network management strategies that mitigate risk, increase operational efficiencies and outpace the competition.
Value-based care
The adoption of value-based care (VBC) solutions is a strategic imperative for health plans today and can create transformational impacts, but often require significant changes to provider relationships, care delivery and payment models. Health plans must increase collaboration among stakeholders and establish new capabilities across people, process, and technology to achieve the goals of their VBC models such as improved health outcomes, quality of care and increased cost-efficiency.
Baker Tilly’s payment transformation framework can help your organization navigate the end-to-end complexities involved in operationalizing value-based care models, from current state feasibility assessments to creating program monitoring structures necessary to scale program successes.
Case study
Large multistate health plan enables performance in value-based program using shared analytics
Read the case studyDigitization
Digital transformation efforts lead to benefits such as improving the accuracy of a health plan’s operations, improving stakeholder trust in technology investments and creating lasting impacts to member health outcomes via reduced care gaps, identification of new opportunities for care coordination and more.
Connectivity between data, systems and insights can be transformative for an organization, but updating legacy platforms and integrating advanced technologies can be challenging. Our health plan solutions help guide your team with a structured approach to enable organizational change, streamline operations and drive greater return from achieving your digital transformation goals.
Case study
Insurance network implements SaaS platform to facilitate growth, decrease manual processes
Read the case studyRisk mitigation and regulatory compliance
Health plans must navigate a complex and evolving regulatory landscape, while constantly burdened with risks that can threaten an organization’s bottom line, expose it to potential government sanctions, HIPPA violations and cybersecurity schemes. Health plans must juggle No Surprises Act (NSA) compliance, adherence to additional interoperability requirements (e.g., CMS Interoperability and Prior Authorization Final Rule), and multiple state regulations, by leveraging strategies that are accurate and defensible during audit to ensure compliance and minimize the risks of large fines and/or reputational damage.
Explore health plan solutions that can help your organization create a strategic, proactive process to reduce inherent risks while maintaining compliance.
Case study
Health plan achieves interoperability compliance through cloud implementation
Read the articleAI readiness and governance
The health insurance industry continues to explore specific AI use cases such as reducing fraud, efficiently processing claims, improving patient care services and examining the potential for AI to predict future healthcare needs, coverage determinations as well as treatment outcomes. As workforce shortages continue to impact health plan member’s access to quality care, AI can offer health plans many benefits such as the reduction of manual processes, support in claims editing and more accurate pricing.
The task of identifying and assessing risks that could arise specifically from AI technologies intersection with the healthcare industry is not trivial. Our health plan solutions can help your organization navigate the AI landscape from AI readiness to governance, benefits and risks included.
Put our health plans and insurance solutions to work for you
Baker Tilly has helped us by providing expert consultants to work and train our development team on new features and functionality within the Microsoft platform, make recommendations on how to implement new features and provide guidance on how to optimize programs and reports we have previously developedDirector, IT development at a large insurance provider offering Individual, Medicare and Employer plans
Other health plan solutions
Healthcare
Baker Tilly helps healthcare organizations address today’s challenges while planning for what’s next through a coordinated approach across the healthcare ecosystem.
Financial Services
The financial services industry continues to diversify, but competition and more complex vendor relationships make determining business strategy more complicated.
Digital Solutions
Foster the future through a continuous culture of innovation.
Risk Advisory
Baker Tilly addresses the full spectrum of risk, governance and compliance considerations in the context of industry, operations and culture.
Internal Audit
Leverage industry-specialized internal audit services for organizational success.
Enterprise Risk Management
Tailored risk management solutions to connect risk and opportunity with performance
Interoperability & System Integration
Enabling better patient outcomes by helping healthcare providers, payers and product companies access and share data across the continuum of care
The pace of change in today’s healthcare market is accelerating.
Change is rapidly transforming the health plan industry in areas that previously had long-term stability. There is a greater need to collaborate with industry partners and stakeholders as the industry continues to shift from the traditional fee-for-service to value-based care (VBC) arrangements — increasing the complexity to adjust or requiring additional bandwidth to fully address this disruption. Health plans need both accounting and health plan specialists with deep knowledge and experience in both healthcare and insurance.
Baker Tilly’s specialized professionals understand the interconnected nature of these key challenges. Contact our team of specialists who provide health plans and insurance solutions that establish a solid fiscal and regulatory base by enhancing organizational operations.
