SOLUTIONS

FOR GOVERNMENT

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, led by Jennifer Eklund, MD, 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.

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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.

Jennifer Eklund, MD

Associate Medical Director, Government Programs

Clinical specialties represented

Radiology

Cardiology

Sleep

Medical Oncology

Radiation Oncology

Genetic Testing

Musculoskeletal

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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.