Health Plans & Managed Care

Health Plan Operations, Strategic Programs, Value-Based Care

Our FTI Consulting Health Plan & Managed Care experts assist our clients with the issues their organizations face today. Our hands-on experience, industry knowledge, and depth of understanding allows us to work closely with our clients on a host of issues including strategy and growth opportunities, core operations, audit & compliance, network development & contracting, government programs, self-insured administration, actuarial services and value-based care.

FTI Consulting’s Health Plan & Managed Care Services

Health Plan Operations
Our client base spans the entire health plan spectrum, from local and regional managed care organizations to large, national health plans. We assist in virtually all aspects of health plan operations, often working directly with the C-suite executives on areas such as strategy, operational alignment and administrative efficiency. Our services include Core Administration, Operational Assessment and Efficiency, Audit & Compliance, Network Contracting, Actuarial, Pharma and Data Management.

Strategic Programs
Our health plan and managed care clients often have a diversified membership base, supporting multiple strategic programs and business units, including Commercial, Medicare Advantage, Managed Medicaid, ACA Marketplace, and Self- Insured Administration. We assist our clients in achieving their overall strategic business objectives, including Efforts to Support Strategy, Operational Transformation, Risk Adjustment, Coding Accuracy, Actuarial, Network Adequacy, and Rate Filing Adequacy.

Value-Based Care
The healthcare marketplace continues the transformation from a fee-for-service based model to one based on value where cost efficiency, quality of care, member experience, and improving the work life of health care providers are equally emphasized. Health plans and managed care organizations are forging new relationships with providers focused on population health, accountable care (“ACOs”), clinically integrated networks, and alternative reimbursement models.

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