Strategic Consulting

Measurable Improvement and Tangible Results

Catalyst Knows the Health Plan Landscape

Delivering Value Through Proven Strategy

The healthcare industry is undergoing a period of unprecedented change. Financial pressures, extraordinary advances in technology, regulatory changes and an increasingly sophisticated consumer base require health plans to be far more proactive than ever before. Moreover, competition between plans is high.

Plans need to understand what products to bring to market and what tools are available to engage their members and providers-all while navigating a landscape full of regulatory, compliance and accreditation complexity. With over 20 years of experience and the knowledge gained from working with over 185 payers, Catalyst can provide health plan executives and board members insights and solutions for strategic initiatives.

Health Plan Strategy

Navigating a Changing World

Competitive Analysis

Uncover Advantages and Opportunities

01

Competition for the business of members and subscribers has never been more heated. Healthcare customers have become better educated and more sophisticated and the choices available to them are increasing. Catalyst’s competitive analysis is invaluable in helping health plans draw up a business plan, expand business, flag competitors in their market, and develop competitive products/offerings.

Catalyst creates a competitive analysis for health plans, helping them to uncover competitive advantage opportunities. This analysis gives plans a greater understanding of the competitors in the market space as well as helping the plan to identify new customers by assessing the demographics of new geographies and by building new products that satisfy those needs. Likewise, Catalyst will evaluate existing products and measure them against those offered by other plans to ensure the plan is providing the best services into the marketplace.

get started
Provider Engagement

Partners with a Purpose

02

Health plans face mounting pressure to improve quality and keep costs down. Catalyst partners with plans to execute a multifaceted provider engagement program that creates the foundation for improved customer engagement, risk-score accuracy, and Star Ratings.

Specifically, Catalyst will improve provider engagement through:

  • Providing consistent communication with physicians that aligns provider behavior with the goals of the plan. High-touch interactions improve provider influence on member compliance and medical record documentation to optimize a member’s healthcare outcomes.
  • Maximizing program effectiveness by allowing providers the flexibility to utilize new technology & processes to reduce provider abrasion.
  • Providing education through various vehicles, including conferences, webinars, and educational materials.
  • Creating incentive models that align with program goals and create positive returns on investment.
get started
Member Engagement

Optimize and Enhance the Member Experience

03

Catalyst works with health plans to improve member engagement and to make data-driven decisions, helping members to live healthier lives. Catalyst will optimize a health plan’s engagement strategy as well as partner with the plan to help better understand the needs of their members and assist the health plan in launching programs that enhance the member experience.

Specifically, Catalyst works with plans on:

  • Targeting specific member populations using data and analytics so the plan can deliver relevant and timely outreach
  • Improving member satisfaction by providing timely and meaningful communications
  • Reducing member abrasion by streamlining communication touchpoints
  • Encouraging improved health through new programs & member engagement services
  • Improving industry ratings by making a positive impact on Health Effectiveness Data and Information Set (HEDIS) scores
    and CMS Star Ratings
get started
LOB Product Design

Lead in the Market, Not Follow

04

For the past 40 years, the rate of healthcare spending has grown at twice the rate of per capita income – this has driven substantial increases in both medical insurance premiums and deductible limits. Catalyst partners with plans to develop new and innovative products that generate revenue while appealing to customers and generate positive healthcare outcomes.

Specifically, Catalyst can help with:

  • Product Development & Strategy
  • Product & Benefit Design
  • Product Management Strategies
  • Bid Design
  • Finance & Actuarial Analysis
  • Sales & Marketing Support
get started
Accreditation

Stimulate & Authenticate Quality Improvements

05

Accreditation and re-accreditation with organizations such as URAC, NCQA, and HEDIS are important requirements for healthcare plans wanting to effectively compete in the marketplace. Accreditation represents a plan’s desire to ensure the quality delivery of various clinical programs, such as case management, utilization review, disease management.

Catalyst helps plans with:

  • Accreditation Preparation
  • Regulatory Compliance
  • Accreditation Program Development
  • Quality Improvement
  • Policy/Procedure Development
  • On-site Mock Surveys
  • Program Development
  • Application Preparation & Submission
  • Healthcare Effectiveness Data and Information Set (HEDIS)
get started
Compliance

Reducing Risk Through Preparedness

06

The regulatory environment is complex and ever-changing. Penalties and fines for non- compliance can have a significant impact on the bottom line of a health plan. Catalyst helps plans ensure compliance programs are effective in detecting and preventing a wide array of compliance issues including medical documentation, billing and coding practices, health and safety, human resources, and HIPAA/HITECH.

Catalyst services include:

  • Compliance Readiness Assessment
  • Risk Assessment
  • Policies & Procedures Updates
  • Compliance Training & Remediation
get started
Digital Evolution

Tailored Digital Solutions

07

The digital transformation of healthcare is underway. The digital advancement of other industries has created consumers who want access to their healthcare information and benefits delivered digitally-and they want ease of use.

Through a collaborative process, Catalyst will work with health plan stakeholders to develop solutions that best address the unique needs and challenges of their plan. Catalyst has in-depth knowledge of the healthcare industry and can provide the services and capabilities the plan needs related to online payment, benefit information, marketing, digital media, social, mobile and analytics.

get started

Client Led Initiatives

Support Services

Catalyst offers several flexible solutions for long and short-term human capital objectives.  Whether a health plan needs an interim executive or a team of claims analysts for overflow capacity, Catalyst provides experienced resources with deep health plan expertise who can immediately hit the ground running.

  • Interim Health Plan Executives
  • Staff Augmentation for Plan Operations & IT Roles
  • Flexible support teams for Claims, Configuration, Testing, Development & Customer Service
  • Catalyst On-Demand support based upon “bucket of hours”
learn more
1