Health plans face significant challenges in today’s healthcare environment, including increased government scrutiny, complex regulatory requirements, renewed strategic partnership, consolidation, and cost management decisions. Managing healthcare cost increases requires addressing systemic obstacles, such as traditional payment models that encourage volume over value, with little financial reward for improving outcomes or preventing disease.
We provide value-based purchasing solutions, which encourage providers to deliver more efficient and effective care. We are at the forefront of payment system design, development, and operations for state and commercial clients, including major health plans, state Medicaid agencies, state employee groups, workers compensation, and automobile liability insurers
Navigant helps payers with all of their program evaluation needs, providing important analysis to support and guide decisions. Our evaluation approach includes program strategy and design, not just outcomes, to ensure that we are looking at the full picture. The results of evaluations can vary from complex statistical analyses to consumer surveys.
Program Implementation and Operations
Our team can help your organization throughout the full life cycle of program implementation, from the initial drafting of the rules, regulations, state plan amendments, and requests for proposals, through the procurement process. After implementation is complete, we provide support to maintain and enhance ongoing program operations. We conduct performance audits, review contract compliance, and evaluate and monitor programs.
Program Strategy and Design
We help payers with support to make critical program strategy and design decisions. Our deep experience, insights, and lessons learned across the full spectrum of healthcare services, help payers make informed, forward-looking strategic and program design decisions.
Navigant works with healthcare providers, payers and pharmacy companies to establish effective privacy and security processes and programs that meet regulatory requirements and safeguard Protected Health Information (PHI).
Disputes & Forensics
We provide information analytics, forensic accounting, and expert testimony skills to help companies and their counsel quantify the potential impact of issues arising in the course of a dispute.
Risk, Regulatory & Compliance
We combine data and forensic expertise with deep industry knowledge to help companies prepare for and respond to information security events.requirements.d to information security events.