Deep expertise for better management of complex government health programs
Our government unit helps health plans navigate the maze of Medicare and Medicaid compliance requirements and ensure evidence-based, affordable care for their beneficiaries. Count on our uniquely qualified team to extend your internal resources for superior management of the complexities of government health programs.
Our depth of government experience helps you stay ahead in a constantly evolving landscape and supports positive Centers for Medicare & Medicaid Services (CMS) star ratings. We routinely monitor CMS updates and ensure quality and compliance through documented CMS-focused training and auditing procedures.
Anchored by our proprietary, technology-driven clinical review process that incorporates both national and local coverage determinations, our solutions align with both state and federal mandates.
A focused approach to government programs
We use a multifaceted approach to help you meet government requirements and guide your beneficiaries to appropriate, safe, and affordable care. In addition to our review process and support programs, we also provide data-rich insights on program performance and practice trends.
- GOVERNMENT-TAILORED CLINICAL APPROPRIATENESS REVIEW
- STATE AND FEDERAL COMPLIANCE PROGRAM
- AUDIT SUPPORT PROGRAM
- CONSULTATION FOR FAIR-COVERAGE HEARINGS
- CMS MONITORING
- PROGRAM PERFORMANCE AND PRACTICE TRENDS REPORTING
Multiply your expertise. Showcase your credibility.
An experienced team of physicians and nurses lead and support our solutions for government. Their expertise across numerous clinical specialties expands your organization’s clinical brainpower and acumen immediately. It also reinforces your clinical credibility and accelerates acceptance among your providers.
Katherine Dallow, MD, MPH
Vice President and Executive Medical Director, Government Programs Strategy and Delivery
Her Role with AIMAs our Vice President and Executive Medical Director for Government Programs Strategy and Delivery, Katherine Dallow, MD, MPH, oversees the successful implementation and delivery of AIM solutions for our health plan clients’ Medicare Advantage and Medicaid members.
Read More about Dr. Dallow
Rupa I. Nimmagadda, MD, MA, serves as a Medical Director for Medicaid Markets at AIM Specialty Health® (AIM). She ensures our solutions meet government program mandates and requirements for Medicaid members. She also provides clinical support during solution implementation.
Read More about Dr. Nimmagadda
Jennifer Eklund, MD, is the Associate Medical Director of Program Integrity and Integration for government programs at AIM Specialty Health® (AIM). In her role, she is responsible for providing leadership and guidance to help ensure the clinical and operational integrity of our solutions for Medicare, Medicaid, and dual-eligible members.
Read More about Dr. EklundClinical specialties represented
Radiology
Cardiology
Sleep
Medical Oncology
Radiation Oncology
Genetic Testing
Musculoskeletal
Related solutions
Radiology Solution
Cardiology Solution
Radiation Oncology Solution
Sleep Solution
Our capabilities, your advantages
Our core capabilities assure your beneficiaries evidence-based care while paving you a path to richer provider collaboration and government compliance.
Aligning care with best practices: clinical appropriateness review
Helping physicians keep up with the latest best practices in evidence-based care is complex. We use our clinical guidelines, physician-led outreach, and innovation to make it easier. It’s our best practice.
Supporting better clinical decisions: provider collaboration
Promoting a continuum of evidence-based care requires a deeper partnership with providers. We engage them from start to finish.
Navigating the new health care landscape
The path to long-term success for health plans involves savings, quality improvements, and closer alignment with members and providers. We can pave that path.