Strategic Health Group - Sample EngagementsSample Engagements

We believe that past performance is the best indicator of future success.  Here are just a few examples of the kind of experience and perspective we bring to each assignment.

Current Engagements

  • The Strategic Health Group’s principals are currently assisting the leadership of a nationally recognized academic geriatric care management group to structure and expand its product offerings to a broader commercial market targeting health plans and ACOs who are at risk for clinical and financial performance.  The client organization has a proven solution for a team based care approach serving a frail, high risk geriatric population.

 

  • The SHG leadership team continues its work to assist health plans successfully evaluate opportunities to serve the Dual Eligible population through assisting a Midwestern client health plan prepare a strategic plan for the development of a Dual Eligible Special Needs Plan (D-SNP) for its service area.  This D-SNP will potentially launch in January 2016.

 

  • The Strategic Health Group leadership team and our strategic partners are currently providing strategy, operational, compliance and financial consulting services to assist a regional integrated delivery system advance its strategic direction to improve capabilities and migrating from a hospital company to a health care company.  Earlier SHG assisted the organization obtain a state license with the California Department of Managed Health Care (DMHC) and submit an application for a Medicare Advantage contract with the Centers for Medicare and Medicaid Services (CMS) for three California counties.

 

  • Strategic Health Group principals have recently completed an engagement to assist a major Western U.S. academic medical center obtain a state license with the California DMHC and position the new plan for obtaining a contract with CMS for a Medicare Advantage plan in Northern California.  SHG’s contribution to the development strategy and financial modeling resulted in no comments from state regulators on the relevant portions of the state license application.  The client will initiate Medicare Advantage operations January 1, 2015.

 

  • SHG leadership is currently assisting a major regional integrated health system on multiple strategic initiatives in response to the business opportunities resulting from the Affordable Care Act.  These initiatives include the further development of the system’s physician clinical integration strategy, the development of new strategic alliances, and strengthening the system’s population management expertise.  SHG’s leadership played a key strategic and financial role in the system’s recent approval from the DMHC  of a Knox Keene Plan to Plan license.

 

  • Assisted the executive leadership of a successful regional health plan explore the strategic implications and challenges of participating in their state’s health insurance exchange.  We worked with plan leadership to understand the plan’s current capabilities, potential barriers and framing execution strategies for exchange participation.

 

  • SHG leadership is currently assisting a major regional integrated health system on development of the structure and licensing to become a Knox Keene licensed plan to accept global risk.  SHG has also assisted the organization with multiple strategic initiatives in response to the business opportunities resulting from the Affordable Care Act. These initiatives include the further development of the system’s physician clinical integration strategy, the development of new strategic alliances, and strengthening the system’s population management expertise.

 

  • Assisted the executive management and Board of Directors of a regional Medicare Advantage plan to assess the risks, challenges and rewards of the plan’s potential participation in the California Coordinated Care Initiative to integrate care for Dual Eligible beneficiaries. Management and the Board are now actively pursuing participation in this program.

 

  • Prepared an assessment on behalf of a major Western managed care company exploring Medicare Advantage growth and expansion strategies to strengthen its leadership position in core markets and expand its service area into new opportunity counties.  We completed a detailed analysis of the company’s current business and capabilities, identified strategies to enhance capabilities and target development opportunities.  Our recommendations included prioritization of opportunities by strategic value as well as return on investment

 

  • Assisted a leading California Medicare Advantage health plan evaluate opportunities for participation in the California Coordinated Care Initiative to integrate care for Dual Eligible beneficiaries.  We worked with plan leadership to identify strategies for direct participation in the program as well as engaging current and future program participants in potential strategic alliances.  We identified critical skills development and a roadmap with executable plans that would allow the plan to succeed in this program serving complex populations.

 

  • Supporting a major California commercial health plan’s  efforts to prepare to become a Qualified Health Plan as part of the California Health Benefit Exchange program to serve the populations that will have access  to health coverage beginning in 2014.  Our work included analysis of provider networks requirements in multiple counties and potential strategic relationships to expand the plan’s footprint.

 

  • Assisted a leading Midwest health insurer prepare a proposal to become a participant in the planned Illinois integrated care program for Dual Eligible beneficiaries. Aided the company to identify several areas, particularly surrounding the care coordination model and enrollee integration, where changes to the plan’s proposed operation would increase the likelihood of success.  Assisted the plan to prepare a detailed operations plan to execute on the program readiness.

 

  • Strategic Health Group has assisted a successful  regional health plan evaluate the business opportunities in a developing state program to provide integrated care for Dual Eligible Beneficiaries. The plan currently serves more than 250,000 commercial, Medicare and Medicaid members. SHG has assisted the plan’s leadership to develop a Medicare Advantage Dual Eligible Special Needs Plan and structure the organizational components necessary to succeed in serving the complex and challenging needs of Dual Eligible Beneficiaries.

 

  • Strategic Health Group has assisted a successful Medicare Advantage health plan explore strategic options for expanding their footprint into a competitive MA market.  This assessment includes evaluation of strategies for aligning the interests of hospitals and physician groups to enhance the opportunity for successful market expansion.  Our actuarial and financial teams are conducting an assessment of the financial, clinical and operational structure necessary to succeed in the new Medicare environment.

 

  • Our leadership team has provided strategic assistance to a private equity firm’s energy efficient lighting system as they prepared to enter the health care space.  Strategic Health Group worked directly with the firm’s principals to help educate them on the intricacies of the health care space and the environmental challenges hospitals and large physician groups are currently experiencing.

Past Successes

  • Our Principals served as key executives in the turnaround of a regional health plan’s financial and operational performance.  The organization went from “near death” to dramatic growth and profitability, adding over $1 billion in retained earnings over six years.  New business and product growth enabled revenue and membership to grow by more than 50%.
  • The leadership of our Principals enabled investors to realize a significant return on investment through the sale of a subsidiary and portfolio companies to strategic investors.  Among these sales were a regional commercial and Medicare HMO to a large “Blue” plan and the sale of a nationally renowned TPA.
  • The Principals of Strategic Health Group have been instrumental in the design and execution of strategic and business operations planning for a variety of health related organizations.  These planning engagements have been conducted for national and regional health plans, state associations, and health technology enterprises.
  • Our Principals have built sophisticated treasury and investment management systems for health organizations with billions of dollars to protect and manage.  The success of these programs resulted from the creation of risk management tools and effective monitoring techniques.
  • Our leadership team has provided critical executive guidance to more than a dozen market expansion and growth efforts in multiple states around the country.  Services have included start-up research and planning, organizational development, state licensing. Medicare Service Area Expansion filings and state Medicaid procurement bids.