The Lewin Group offers a full range of services in the design, implementation and evaluation of cost-effective, quality-oriented health care delivery and benefits management programs. Among our principal clients are health insurers, managed care organizations, specialty benefits administrators and provider groups/systems.

Key Services

• Supporting insurers/MCOs with strategic and business planning, market research including competitive assessments, and product development including target market recommendations, benefit design, rates, distribution methods, etc.
• Assisting health plans of all sizes, at various stages of development, with implementing or strengthening all areas of operations, including vendor procurement and system implementation.
• Advising insurers/MCOs in the areas of information technology, provider contracting, provider partnership development, pharmaceutical benefit cost containment, care management and public policy impact analysis.
• Assisting state governments, MCOs, providers, and localities to design, build, operate and monitor managed care programs for Medicaid and Medicare beneficiaries.
• Helping hospitals, physician groups and other providers to optimize their relations with purchasers and health plans and assisting in the development of operational, financial and clinical management capabilities necessary to succeed in the managed care environment.

Sample Projects

• Researched and developed a new provider strategy for a large Blue Cross Blue Shield plan, aimed at enabling the company to forge more collaborative, sustainable relationships with hospitals and physician organizations throughout its market.
• Conducted a comprehensive competitive market assessment for a major health plan.
• Developed actuarially sound capitation rates for multiple Medicaid managed care programs, including several programs serving persons with special health care needs.
• Worked extensively with a regional health system to form and implement a managed care organization. Prepared all required documents for the Department of Insurance. Coordinated all implementation activities pertaining to the managed care information system, facility issues, staffing, training, network development, provider contracting, provider education, member education and marketing.
• Assisted a large national health insurance provider in devising a strategy to offer a national HMO product.
• Aided a health plan-nephrology group partnership in applying to the federal government for participation in the ESRD Managed Care Demonstration, including service package development, risk-sharing arrangements, marketing approach, and preparation of narrative sections of the proposal.
• Conducted an assessment of the ancillary services market (e.g., pharmacy, mental health, lab, vision) and how large national health insurers contract for these services.
• Worked with multiple provider consortia and state agencies to develop special needs managed care programs to serve children with special health care needs, persons with HIV, and adults with mental health and substance abuse diagnoses.

For more information on our specialized managed care consulting services, please contact The Lewin Group