Wouldn’t it be refreshing to have a conversation with someone who understands your business and can implement solutions that fit the unique needs of your organization?

The pace of change in today’s healthcare market is accelerating. From the constant uncertainty in regulatory mandates, increasing demands to deliver sustainable reductions in medical expenses and higher expectations for consumer-centric services and solutions, to the growing threat of large-scale disruption from InsurTech and inter-industry mergers and acquisitions, health insurance companies need accounting and consulting specialists with deep knowledge and experience in both healthcare and insurance.

Baker Tilly’s specialized professionals combine nimbleness with candid, pragmatic recommendations and technical expertise. Among our health plan clients, we have built a reputation for:

  • Delivering solutions and capabilities that exceed expectations for business value
  • Collaborating with a flexible and proactive approach
  • Demonstrating a commitment to excellence and integrity that consistently surpasses experiences with other firms
  • Providing deep industry knowledge as one of the largest health insurance auditors in the U.S.

Our primary areas of practice address the key challenges currently facing our clients:

Financial Health: Tax, audit and risk

To sustainably grow your business, you need a solid base including financial health, compliance with regulations, and clear risk assessment and mitigation strategies. Benefit from our dedicated industry specialized professionals who thoroughly understand your operations, regulations and risks.

Risk Optimization: End-to-end risk adjustment

Healthcare risk optimization is all about accuracy, quality and a prospective view of risk and opportunity. We work with our clients to break down barriers between historical care management and risk adjustment functions, while building a strong foundation of data management, analytics and operational processes that will help them persevere and succeed regardless of environmental, regulatory and market changes. 

Payment Transformation: Fee for value (FFV)

For many of our health plan clients, the shift to fee for value (FFV) is the #1 strategic imperative – yet initiatives to drive towards this objective are led by a variety of potentially disconnected business and clinical organizations. We understand the organizational, data, analytics, and integration (provider, internal, vendor) challenges that face our clients as they work to overhaul their core operations in pursuit of value.

  • Population identification
  • Cost efficiency measurement
  • Quality outcome measurement
  • Provider analytics
  • Financial settlement
  • Care management delegation

Consumer Engagement: Consumer-centricity

We work with our health plan clients to help them build the right mix of processes and technology to create REAL consumer-centricity. We define the health plan consumer as anyone who is a member today, has been a member in the past, or could be a member in the future. This simple, straightforward point of view helps us push our clients towards building foundational and tactical approaches to engaging consumers.

  • Foundational capabilities
    • Acquire, Manage and Organize Individual-Level Data
    • Build Meaningful Insights About Individuals
    • Integrate and Align Processes and Systems
  • Consumer Engagement Across the Journey (acquisition, service, care management, retention)
    • Develop and Manage Content and Assets
    • Interact with Consumers at the Right Time, with the Right Message, via the Right Channel
    • Optimize Overall Engagement Performance

Wide array of services

Benefit from a wide array of services designed to help you achieve success, including:

  • Defining and building operational capabilities (e.g., enrollment, claims processing, compliance filings, integration with government platforms, CRM / member response, etc.) to drive foundational enhancements to support today’s initiatives or quickly respond to new regulatory mandates,
  • Defining and building new financial risk sharing models to “bend the cost curve” while supporting quality of care improvements,
  • Responding to shifting customer expectations in transparency and access to care, and
  • Addressing the need for a more agile workforce.
Build a sustainable cybersecurity program

Build a sustainable cybersecurity program

Insurance organizations must review their cybersecurity programs now and enact sustainable cybersecurity management that is adaptable to evolving threats and oversight requirements while remaining aligned to the organization's culture and objectives. A sustainable cybersecurity management program – one that is proactive, sound, and aligned to business and organizational risks – begins here.

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Healthcare: Customer Experience

Healthcare: Customer Experience

Many trends across the healthcare industry today are converging. A common theme emerging from their overlap is the need for industry participants to focus on customer experience programs. Learn about four major trends that are impacting the importance of customer experience in healthcare.

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