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OUR PROJECTS
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Advanced Care Management Strategies
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Network Development/Managed Care Contracting
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Network Promotion & Representation
Missouri Health Plus is a patient centered medical home network created around the 26 Missouri Federally Qualified Health Centers (FQHC’s). Collectively, these health centers represent over 300 primary care physicians throughout the state. The network was organized around a clinical integration model and successfully contracted with the three major Medicaid HMO’s offered in Missouri. The contracts included pay for performance, shared savings, and care coordination fees to the provider organization.
This is an example of how individual providers can align to achieve market power, influence change, and to improve their standing in the market. In addition, the parties achieved a new level of payor/provider collaboration through this entity. INNOVA used its managed care background and experience, extensive business relationships in the market, and leadership skills to facilitate the development, promotion, and contracting of this new health care organization with market payors.
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Implementation of Advanced Care Management Strategies
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Business Planning & Strategic Growth Strategies
INNOVA presented their innovative collaboration network strategy to the Mercy health system in order to allow them to meet market demands. The collaborative network offers risk-based contracting and provides benefits and resources to partnered providers.
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Development of Innovative Benefit Plan Design
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Business Planning & Strategic Growth Strategy
INNOVA has worked with many large employers on innovative benefit plan designs. On this project INNOVA assisted our Post Holdings in reaching their employer health care benefit goals. Our team developed a strategic and innovative approach to manage health benefits to assist the client in taking a business planning approach to employee benefits.
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Selection and Implementation of EHR System
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Competitor Analysis
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Suggested Next Steps
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Selection of Telehealth Program
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Sales and Marketing Plan Implementation
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Identification of Major Sales Channels
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Representation of Client to Health Plans/Systems
Our team has the expertise to serve our clients in the selection and implement Electronic Health Record (EHR) systems. The EHR selection process is a comprehensive approach which includes literature review, user needs and business requirements, competitor analysis regarding their utilized EHR, request for proposal (RFP) development, extensive vendor proposal evaluation as well as suggested next steps.
In this specific project, INNOVA provided assistance to a long-term care organization. Long term care providers have moved slowly and cautiously to implement EHR systems based on the lack of clear direction on meaningful use requirements and interoperability. Other barriers have included the absence of federal stimulus funding for long term care providers, the high cost of EHR systems, implementation challenges, lower financial margins in the sector, and lack of information technology (IT) resources and expertise. Regardless of these issues, the importance of keeping pace with the acute care sector in order to maintain business working relationships to smooth transitions of care and to generate increasing referral business from these providers is detrimental to long term care organizations.
INNOVA has the ability to help both payers and health systems plan for and select telehealth programs, remote patient monitoring, and telemedicine.
On a previous project INNOVA had the opportunity to support AMC Health by implementing and launching their sales and marketing plan. This plan included the major sales channels of health systems, health plans, post-acute care, and government programs. In doing this, INNOVA represented the client to many health plans and health systems. We also maintained extensive involvement in the competitive bid process evaluation of the features, benefits, strengths, and weaknesses of different vendor offerings.
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Network Development/Managed Care Contracting
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Strategic Growth Strategy
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Research and Data Analytics
Avant is a program designed to capitalize on the savings and efficiency of outpatient surgery programs in the delivery of healthcare services. The purpose of the ambulatory surgery network is to help them to achieve market power to promote their easy access, higher quality, and to command more favorable rates. Our team developed this ambulatory surgery network on behalf of National Medical Billing Services, a billing service with more than 300 ambulatory surgery clients across the nation. The infrastructure developed included staffing, facilities, systems, and processes to support sales and marketing, network development, provider relations, care management, bundled payments, clinical integration, claims repricing, accounting, and data analytics. INNOVA regularly represents ambulatory surgery centers in contract negotiation with health plans.
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Development of Innovative Benefit Plan Design
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Business Planning & Strategic Growth Strategy
INNOVA partnered with this client to assist with their benefit plan design. Our team provided new strategies that included the establishment of an aggressive program to focus on the high risk cases that are driving most of their health care costs. As well as an evaluation of funding options, development of corporate health culture that is designed to drive wellness, and evaluation of network configuration options (ACO’s, etc.) and suggested next steps.
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Delivery of Comprehensive Analysis of the Available Internal and External Resources
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Strategic Next Steps Recommendations
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Extensive Competitor Analysis
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Business Planning & Strategic Growth Strategies
INNOVA assisted Centene with the creation of a comprehensive strategic business plan to develop a management services capability that includes advanced clinical and financial technology, and other related infrastructure for provider sponsored ACO’s. Our team also delivered a clear and objective analysis of the current ACO marketplace that included a list of the current ACO’s with ownership, location, and executive contact listing.
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Market Feasibility Study
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Data Analytics on Cost of Medical Care
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Business Planning & Strategic Growth Strategies
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Network Development/Managed Care Contracting
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Implementation of Advanced Care Management Strategies
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Representation of the Client to Large Health Systems
The INNOVA team has aided one of the largest retail pharmacy chains in the nation with the analysis of a strategic business plan; which would include the build out of a network including physicians, pharmacies, and clinics. Several of the services our team was able to provide amidst the network development involved promotion of primary care networks to priority markets, creation of provider contracts for network participation, introduction of a system to identify lead physicians, as well as assistance to the client in negotiations with large health systems. INNOVA not only proposed strategy for the client’s business development, but also participated in provider rate development, health plan and employer marketing, network analytics, EMR evaluation, and the revision of all the client’s contracts in the development process.
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Business Planning & Strategic Growth Strategy
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Network Development/Managed Care Contracting
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Implementation of Advanced Care Management Strategies
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Data Analytics on Cost of Medical Care
We have participated in implementing care coordination services and related infrastructure in support of community physicians based on the CMS Chronic Care Management program for providers. This innovative CMS program introduces new practice revenue for physicians, nurse practitioners and other health care professionals for performing expanded services of care coordination for high risk Medicare seniors.
Practicing physicians have been slow to adopt this new program even with the promise of substantial new revenue. The reluctance is related to CMS added requirements for practice infrastructure, additional staff, meaningful use technology and detailed documentation. INNOVA’s market feasibility, legal feasibility, information systems plan, and financial projections help to relieve the physician reluctance.
INNOVA worked with this client in the creation of a network that included post-acute care providers. Throughout this specific project, the network of providers was introduced as a ready-made network for contracting with Medicare Advantage Health Plans, ACO’s, and hospital systems. The strategy in this scenario serves its senior care company owners and investors in managing through the profound health care industry shifts in focus of care management and value-based reimbursement methodologies. Doing so by offering an effective vehicle for joint planning and development in key areas of health care guidelines, information systems and software applications, clinical analytics, financial analysis and best operational practices to achieve significant improvements in efficiency. INNOVA aided the client’s leaders in seeking to develop a proactive stance in structuring care management solutions to effectively deliver high quality care at manageable costs while also improving the patient experience with post-acute care services and the health care delivery system as a whole. Care management strategies provided by INNOVA monetarily benefited this specific client and can support potential clients in many aspects.
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Client Representation
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Strategic Development and Implementation of Benefit Plan Design
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Data Analytics on Cost of Medical Care
Ambulatory surgery centers are emerging as reliable facilities for a growing number of surgical procedures. These free-standing centers offer convenient access, comfortable setting combined with lower cost and documented higher quality of outcomes. Yet health plan payers tend to undervalue ASC’s with reimbursement and with benefit design for employees and members to utilize these programs. INNOVA represents numerous Ambulatory Surgery Center programs in promoting services to health plan payers. INNOVA also crafts benefit design incentives for employers and payers to steer increased utilization to these high value facilities offering outpatient surgical services.
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Client Representation
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Manage Payor Contracting
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Financial Analytics
Heartland Women's Healthcare is a specialty physician group practice with over 50 clinical professionals. In addition to 30 OB/GYN physicians Heartland has over 20 clinical professionals such as FNPs CNMs and WHNPs. Heartland practices in 27 locations in Missouri and Southern Illinois and delivers over 3,000 newborns each year.
In addition to our primary role which directs and manages all payer/managed care contracting for Heartland, Innova Health Solutions provides additional financial services including claim studies, new venture evaluation and analysis and support for grant requests.