SERVICES
OUR expertise
Health Plan Operations
Efficiency is no longer a competitive advantage, it is a necessity.
Continually evaluating systems and processes supports successful operations. 32nd Note offers a team of health plan experts with Six Sigma/Lean Certifications who drive process improvement that will result in cost savings and member satisfaction. Our experts provide end to end operational implementation, policies and procedures, assessments, process improvement, root cause analysis, corrective action implementation, quality assurance programs and training services.
- MEMBER AND PROVIDER CONTACT CENTER
- HEDIS AND STAR RATING STRATEGIES
- MARKETING AND SALES OPERATIONS
- APPEALS AND GRIEVANCES
- CLAIMS ADMINISTRATION
- PRIOR AUTHORIZATION
- PROVIDER NETWORK
Non-compliance can be costly.
Health Plans face strict compliance requirements by States and the Centers for Medicare and Medicaid Services. The integration of programs requires understanding of complex regulatory compliance that overlap state Medicaid and Medicare rules. Without proper proactive oversight and controls, plans risk having regulatory enforcement actions in the form of civil monetary penalties, intermediate sanctions and termination of health plan contract. 32nd Note can identify areas of risk and non compliance and help clients close the gaps. Our team can provide immediate support when faced with regulatory notices that require prompt attention.
- COMPLIANCE PROGRAM
- DELEGATION OVERSIGHT
- ANNUAL RISK ASSESSMENT
- INTERNAL AUDIT
- CMS PROGRAM AUDIT
- CORRECTIVE ACTION PLAN
- READINESS REVIEW PREPARATION
An increase in pharmaceutical cost and complexity has increased the need for more robust programs.
The focus on Pharmacy Management has become critical as programs continually integrated Medicare-Medicaid services. The higher prevalence of chronic conditions and social determinants of health has added to the clinical complexity making it difficult to manage care and take medications. Oversight of Part D operations continue to be a core component of CMS audits and State agencies. Due diligence, operational rigor and self-monitoring is vital to avoiding sanctions, fines and poor Star Ratings. 32nd Note has broad experience in pharmacy management and includes the following services:
- MTM PROGRAM
- PBM OVERSIGHT
- COVERAGE DETERMINATION/REDETERMINATION
- PART D AUDIT AND REMEDIATION
PART D ASSESSMENT AND READINESS
High-quality health care organizations create an environment of continuous learning and culture of excellence.
32nd Note consultants can support a cross-departmental collaboration model that builds and ensures continuous feedback and progress. The team consists of MBA, Certified Professional in Health Care Quality (CPHQ) by the National Associatio for Health Care Quality (NAHQ). The team is comprised of strong analytical and data minded individuals who rely on PDSA and process improvement strategies to support quality initiatives and program evaluations. Scope of services include:
- PROGRAM DESCRIPTION DESIGN
- PROGRAM IMPLEMENTATION
- PROGRAM MONITORING AND EVALUATION
- POTENTIAL QUALITY OF CARE CONCERN PROCESS
- HEDIS STRATEGIES AND MONITORING
Times have changed and there is much more value on a leader who is open to listening to others and participating on a team.
A healthcare leader of the future needs to be an independent thinker who understands the emerging healthcare market, be passionate about serving the needs of the customer, be a change agent for their organization, be able to motivate and inspire and run a lean, high quality organization. 32nd Note provides the following services:
- INTERIM LEADERSHIP ROLE
- LEADERSHIP TRAINING
- MENTORING AND COACHING
- SUCCESSION PLANNING