OUR CONSULTING SERVICES
Health Plans Sales and operations is our lives and expertise with 90+ years combined Plan Start up, Operations, Marketing, Sales and Retention Experience.
We are pleased and happy to offer our Consulting Services
We are pleased and happy to offer our Consulting Services
Our Principles have a demonstrated and diversified Leadership and Strategy success track record in the NY/NJ/PA/MI and other national Managed Care Markets.
OUR SERVICES
Plan Start-Up Design and Launch:Creating and executing a comprehensive strategy to introduce new health plans into the market.
This involves designing a health plan from the ground up, including market analysis, regulatory compliance, network development, and the creation of benefits and pricing structures. The launch phase includes preparing marketing campaigns, building sales strategies, and establishing operational processes to ensure a successful entry into the market, driving both growth and sustainability from day one.
Network Development:
Building efficient provider partnerships that balance cost and care quality.
Network development focuses on creating and maintaining relationships with healthcare providers, ensuring that members have access to quality care while controlling costs. This involves carefully selecting and negotiating with hospitals, doctors, specialists, and clinics to build a comprehensive and efficient network.
Pharmacy Benefit Management (PBM) & Formulary Design:Cost containment strategies with improved pharmaceutical access.
PBM involves managing prescription drug benefits to ensure cost-effective access to medications while maintaining high-quality care. Formulary design plays a critical role by creating a list of approved medications based on their effectiveness, cost, and safety, ensuring that members have access to essential drugs at competitive prices.
Product and Benefit Design:
Tailored insurance products for diverse market segments.Product and benefit design involves crafting insurance offerings that meet the specific needs of various market segments. This includes designing coverage options, co-pays, and premiums that appeal to different demographic groups, ensuring that plans are both comprehensive and financially viable for consumers.
Operational Systems Acquisition and Workflow Development:Implementing and optimizing systems and processes to improve efficiency and support scalable operations.
This involves selecting and acquiring the right operational systems (e.g., claims processing software, CRM tools, care management platforms) to streamline internal workflows and enhance productivity. Workflow development focuses on designing seamless processes that ensure smooth communication, reduce bottlenecks, and enhance service delivery, leading to cost savings, faster response times, and improved overall operations.
Operational Improvements:Streamlined systems for claims processing, care management, and member engagement.
Operational improvements focus on optimizing internal processes to ensure that claims are processed efficiently, care is managed effectively, and members are engaged through personalized services. This can involve automating workflows, integrating technology, and implementing best practices to improve the overall member experience while reducing administrative costs.
Member Services and Contact Centers Development:Designing and optimizing member support systems to enhance customer satisfaction and engagement.
This involves creating and managing efficient member services and contact centers that provide prompt and effective assistance to members. The development focuses on training customer service representatives, implementing technology for quicker issue resolution (such as chatbots and automated systems), and creating a seamless process for inquiries, claims support, and health-related questions. The goal is to improve member experiences, increase retention, and offer personalized service that meets the diverse needs of the membership base.
Training, Learning, and Development:
Building and implementing educational programs to enhance employee skills, performance, and growth.
This involves designing training programs that cater to the needs of employees at various levels, focusing on skill development, industry knowledge, and compliance. The learning initiatives aim to improve overall performance, foster continuous professional growth, and ensure staff are well-equipped to meet the evolving demands of the healthcare industry. This can include onboarding, leadership development, technical skills training, and ongoing professional development to drive employee engagement and organizational success.
Sales, Marketing, and Growth Strategy:Innovative approaches to expand membership and enhance customer satisfaction.
Developing sales and marketing strategies that effectively attract new members and retain existing ones. This includes using innovative marketing techniques, customer engagement tools, and outreach programs to build brand awareness, increase market share, and foster long-term relationships with clients.
Medicare/Medicaid/MLTC/MLTSS/ACA Sales Strategy DevelopmentDeveloping sales strategies for health plans under programs such as Medicare, Medicaid, Managed Long-Term Care (MLTC), Managed Long-Term Services and Supports (MLTSS), and the Affordable Care Act (ACA). This includes targeting the right demographics, understanding regulatory requirements, and creating compelling value propositions to attract members.
AssessmentsConducting detailed assessments of market conditions, competitive analysis, and internal capabilities to identify growth opportunities, evaluate current strategies, and address challenges within the sales process.
Sales and Marketing Growth Plans Development Including: G.H.O.S.T Protocols
Creating comprehensive sales and marketing growth plans based on strategic frameworks such as G.H.O.S.T (Goals, How, Objectives, Strategies, and Tactics). This ensures alignment with business goals and sustainable growth through structured planning.
Sales Operations and Systems
Designing and implementing efficient sales operations and systems that streamline processes, track progress, manage customer relationships, and optimize overall sales efforts.
Sales Effectiveness and Optimization
Evaluating and improving sales effectiveness by assessing performance, identifying areas for improvement, and optimizing sales techniques, tools, and strategies to achieve better results.
Sales and Marketing Budget Forecast and Projections Model Design
Creating financial models for sales and marketing budgets, including forecasting revenue, projecting expenses, and setting targets for growth while aligning with the organization's financial goals.
Sales Teams and Leadership Developments and Effective Deployment
Developing and training sales teams, equipping them with leadership skills, and ensuring the strategic deployment of resources to maximize productivity, motivation, and success across all levels.
Brokers and FMO Acquisition and Contracting
Acquiring and contracting with brokers and Field Marketing Organizations (FMOs) to expand market reach and grow the distribution network. This includes negotiating contracts, setting terms, and building mutually beneficial relationships.
Effective Sales Training Using the S.M.A.R.T Objectives Success Formula
Implementing sales training programs based on the S.M.A.R.T (Specific, Measurable, Achievable, Relevant, Time-bound) objectives formula, ensuring that training is targeted, actionable, and leads to measurable improvements in performance.
Field Marketing and Tactics Including Community Outreach and Events Planning
Developing field marketing strategies that focus on direct engagement with communities through events, outreach programs, and grassroots campaigns designed to build brand awareness and attract potential members.
Grass Roots and Marketing Campaigns
Designing and executing grassroots marketing campaigns that focus on building relationships within local communities, often through word-of-mouth, local events, and direct involvement to increase visibility and brand loyalty.
Provider Marketing Strategy
Creating and executing marketing strategies aimed at healthcare providers (e.g., doctors, hospitals, clinics) to build partnerships, increase referrals, and expand the reach of health plans.
Membership Retention and Concierge Experience
Developing strategies to enhance member satisfaction, increase retention, and offer personalized services through a concierge experience, ensuring members feel valued and supported throughout their healthcare journey.
Sales and Marketing Compliance
Ensuring all sales and marketing activities comply with industry regulations, including healthcare laws and guidelines such as HIPAA, ACA, and state-specific regulations.
Compliance Monitoring Services
Providing ongoing monitoring services to ensure that sales and marketing activities remain compliant with regulatory standards and that any potential violations are identified and addressed promptly.
Tele-sales, Brokers, Captive Agents, Customer Service Call Centers
Developing and managing tele-sales strategies, including training brokers, captive agents, and customer service call centers to provide effective support, lead generation, and customer retention efforts.
Territory Management and Expansion Strategy and Tactics
Creating strategies for territory management that optimize coverage areas, expand market presence, and increase sales opportunities by targeting under-served regions or customer segments.
Benefit Design and Planning
Designing benefits packages that are attractive to potential members while meeting regulatory requirements, optimizing cost efficiency, and ensuring adequate healthcare coverage.
Sales Compensation and Incentives Models Development
Creating and managing sales compensation and incentive models that drive motivation, reward performance, and align with the company's overall sales goals and strategy.
Onsite Presence and Oversight of Sales Activities
Providing on-the-ground oversight and support for sales activities, ensuring that teams are following best practices, staying compliant, and meeting targets through continuous monitoring and hands-on management.
Sales Reports and Dashboard Models Advice
Advising on the creation of sales reports and dashboards that provide real-time insights into performance metrics, KPIs, and other critical data, helping leadership make informed decisions and optimize sales strategies.
Worldwide Availability
Offering services and expertise on an international scale, ensuring that the strategies and solutions provided can be implemented across multiple regions to support the growth of health plans across the country and worldwide.
This involves designing a health plan from the ground up, including market analysis, regulatory compliance, network development, and the creation of benefits and pricing structures. The launch phase includes preparing marketing campaigns, building sales strategies, and establishing operational processes to ensure a successful entry into the market, driving both growth and sustainability from day one.
Network Development:
Building efficient provider partnerships that balance cost and care quality.
Network development focuses on creating and maintaining relationships with healthcare providers, ensuring that members have access to quality care while controlling costs. This involves carefully selecting and negotiating with hospitals, doctors, specialists, and clinics to build a comprehensive and efficient network.
Pharmacy Benefit Management (PBM) & Formulary Design:Cost containment strategies with improved pharmaceutical access.
PBM involves managing prescription drug benefits to ensure cost-effective access to medications while maintaining high-quality care. Formulary design plays a critical role by creating a list of approved medications based on their effectiveness, cost, and safety, ensuring that members have access to essential drugs at competitive prices.
Product and Benefit Design:
Tailored insurance products for diverse market segments.Product and benefit design involves crafting insurance offerings that meet the specific needs of various market segments. This includes designing coverage options, co-pays, and premiums that appeal to different demographic groups, ensuring that plans are both comprehensive and financially viable for consumers.
Operational Systems Acquisition and Workflow Development:Implementing and optimizing systems and processes to improve efficiency and support scalable operations.
This involves selecting and acquiring the right operational systems (e.g., claims processing software, CRM tools, care management platforms) to streamline internal workflows and enhance productivity. Workflow development focuses on designing seamless processes that ensure smooth communication, reduce bottlenecks, and enhance service delivery, leading to cost savings, faster response times, and improved overall operations.
Operational Improvements:Streamlined systems for claims processing, care management, and member engagement.
Operational improvements focus on optimizing internal processes to ensure that claims are processed efficiently, care is managed effectively, and members are engaged through personalized services. This can involve automating workflows, integrating technology, and implementing best practices to improve the overall member experience while reducing administrative costs.
Member Services and Contact Centers Development:Designing and optimizing member support systems to enhance customer satisfaction and engagement.
This involves creating and managing efficient member services and contact centers that provide prompt and effective assistance to members. The development focuses on training customer service representatives, implementing technology for quicker issue resolution (such as chatbots and automated systems), and creating a seamless process for inquiries, claims support, and health-related questions. The goal is to improve member experiences, increase retention, and offer personalized service that meets the diverse needs of the membership base.
Training, Learning, and Development:
Building and implementing educational programs to enhance employee skills, performance, and growth.
This involves designing training programs that cater to the needs of employees at various levels, focusing on skill development, industry knowledge, and compliance. The learning initiatives aim to improve overall performance, foster continuous professional growth, and ensure staff are well-equipped to meet the evolving demands of the healthcare industry. This can include onboarding, leadership development, technical skills training, and ongoing professional development to drive employee engagement and organizational success.
Sales, Marketing, and Growth Strategy:Innovative approaches to expand membership and enhance customer satisfaction.
Developing sales and marketing strategies that effectively attract new members and retain existing ones. This includes using innovative marketing techniques, customer engagement tools, and outreach programs to build brand awareness, increase market share, and foster long-term relationships with clients.
Medicare/Medicaid/MLTC/MLTSS/ACA Sales Strategy DevelopmentDeveloping sales strategies for health plans under programs such as Medicare, Medicaid, Managed Long-Term Care (MLTC), Managed Long-Term Services and Supports (MLTSS), and the Affordable Care Act (ACA). This includes targeting the right demographics, understanding regulatory requirements, and creating compelling value propositions to attract members.
AssessmentsConducting detailed assessments of market conditions, competitive analysis, and internal capabilities to identify growth opportunities, evaluate current strategies, and address challenges within the sales process.
Sales and Marketing Growth Plans Development Including: G.H.O.S.T Protocols
Creating comprehensive sales and marketing growth plans based on strategic frameworks such as G.H.O.S.T (Goals, How, Objectives, Strategies, and Tactics). This ensures alignment with business goals and sustainable growth through structured planning.
Sales Operations and Systems
Designing and implementing efficient sales operations and systems that streamline processes, track progress, manage customer relationships, and optimize overall sales efforts.
Sales Effectiveness and Optimization
Evaluating and improving sales effectiveness by assessing performance, identifying areas for improvement, and optimizing sales techniques, tools, and strategies to achieve better results.
Sales and Marketing Budget Forecast and Projections Model Design
Creating financial models for sales and marketing budgets, including forecasting revenue, projecting expenses, and setting targets for growth while aligning with the organization's financial goals.
Sales Teams and Leadership Developments and Effective Deployment
Developing and training sales teams, equipping them with leadership skills, and ensuring the strategic deployment of resources to maximize productivity, motivation, and success across all levels.
Brokers and FMO Acquisition and Contracting
Acquiring and contracting with brokers and Field Marketing Organizations (FMOs) to expand market reach and grow the distribution network. This includes negotiating contracts, setting terms, and building mutually beneficial relationships.
Effective Sales Training Using the S.M.A.R.T Objectives Success Formula
Implementing sales training programs based on the S.M.A.R.T (Specific, Measurable, Achievable, Relevant, Time-bound) objectives formula, ensuring that training is targeted, actionable, and leads to measurable improvements in performance.
Field Marketing and Tactics Including Community Outreach and Events Planning
Developing field marketing strategies that focus on direct engagement with communities through events, outreach programs, and grassroots campaigns designed to build brand awareness and attract potential members.
Grass Roots and Marketing Campaigns
Designing and executing grassroots marketing campaigns that focus on building relationships within local communities, often through word-of-mouth, local events, and direct involvement to increase visibility and brand loyalty.
Provider Marketing Strategy
Creating and executing marketing strategies aimed at healthcare providers (e.g., doctors, hospitals, clinics) to build partnerships, increase referrals, and expand the reach of health plans.
Membership Retention and Concierge Experience
Developing strategies to enhance member satisfaction, increase retention, and offer personalized services through a concierge experience, ensuring members feel valued and supported throughout their healthcare journey.
Sales and Marketing Compliance
Ensuring all sales and marketing activities comply with industry regulations, including healthcare laws and guidelines such as HIPAA, ACA, and state-specific regulations.
Compliance Monitoring Services
Providing ongoing monitoring services to ensure that sales and marketing activities remain compliant with regulatory standards and that any potential violations are identified and addressed promptly.
Tele-sales, Brokers, Captive Agents, Customer Service Call Centers
Developing and managing tele-sales strategies, including training brokers, captive agents, and customer service call centers to provide effective support, lead generation, and customer retention efforts.
Territory Management and Expansion Strategy and Tactics
Creating strategies for territory management that optimize coverage areas, expand market presence, and increase sales opportunities by targeting under-served regions or customer segments.
Benefit Design and Planning
Designing benefits packages that are attractive to potential members while meeting regulatory requirements, optimizing cost efficiency, and ensuring adequate healthcare coverage.
Sales Compensation and Incentives Models Development
Creating and managing sales compensation and incentive models that drive motivation, reward performance, and align with the company's overall sales goals and strategy.
Onsite Presence and Oversight of Sales Activities
Providing on-the-ground oversight and support for sales activities, ensuring that teams are following best practices, staying compliant, and meeting targets through continuous monitoring and hands-on management.
Sales Reports and Dashboard Models Advice
Advising on the creation of sales reports and dashboards that provide real-time insights into performance metrics, KPIs, and other critical data, helping leadership make informed decisions and optimize sales strategies.
Worldwide Availability
Offering services and expertise on an international scale, ensuring that the strategies and solutions provided can be implemented across multiple regions to support the growth of health plans across the country and worldwide.