Consulting and Technical Assistance

Growth + Profitability Strategy

Caremetrics Consulting assists our clients in planning and executing sustainable growth and financial success in managing complex populations, including all aspects of administrative and clinical operations, business development and alliances, and transformational change.

Our team is fluent in emerging healthcare technologies for both payers and providers, including traditional and emerging business intelligence platforms, transaction processing, EMR/EHR, eCommerce, social networking, mobile computing, mobile diagnostics and biometrics, and direct-to-Consumer engagement.

Set-Up, Readiness & Launch of New Plan Products

Caremetrics provides hands-on support in the planning, build-out and go-live of new or expansion benefits products focused on complex populations, such as D-SNPs, MLTC, dual eligibles MMPs, PCMH and others.  Our work spans initial fit-gap assessments, bidding process, regulatory filings, preparedness for State and CMS Readiness Reviews and post go-live compliance.  We work with each major department in a health plan, including network development, member services, claims system configuration,  medical & payment policy, UM/medical management, IT and enterprise analytics, procurement, appeals and grievances, finance and reporting.  Our experience includes building-out new plans from scratch, building on Medicare and Medicaid platforms, and developing joint venture partnerships, including operationalizing the division of responsibilities among the JV partners.

Project Management | PMO

Caremetrics Consulting has deep experience in large multi-dimensional enterprise transformations, mergers, and IT installations.  Our team understands the full project life cycle, and provides an important bridge between today’s ongoing operations and the intended future state goal.  We are experts at defining requirements, managing complex relationships, building and concurrently leading multiple project teams, developing sustainable processes and methodologies, and enhancing stakeholder satisfaction.