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We employ expertise with deep healthcare payer knowledge to cost-effectively drive profitable revenue on behalf of our Portfolio Companies. We support our business development initiatives with operational project management based on actual experience working in the payer, provider and service sectors. Our specialization ensures that every relationship fostered by Leverage Health is efficiently and cost-effectively implemented with all parties’ expectations optimally satisfied.
The healthcare payer market is in the midst of unprecedented change. While employer-based coverage has been the insurance program for the majority of Americans for the last few decades, Americans are increasingly joining government-sponsored programs, given the aging of Baby Boomers, the expansion of Medicaid, and the creation of public exchanges and marketplace subsidies. Most commercial health plans are growing their participation in these programs as the government expands its approach to nationalized, privatized coverage.
To thrive in this new environment, health plans must change the way they operate. Payers require completely different capabilities, organizational models, and technologies to manage direct-to-consumer coverage. Understanding consumer populations is more critical than ever, as is developing economies of scale.
As Medicare, Medicaid, and Exchange populations expand, health plans must increase operational efficiencies, automate antiquated processes, and quickly address existing capability gaps.
A transformation is underway in the health insurance marketplace. With the passing of the Affordable Care Act, health insurance is shifting from employer-based coverage to coverage purchased directly by individual consumers from health plans.
To remain competitive and relevant, health plans must expand their acquisition, administration, and retention efforts beyond brokers and large employers and address the unique requirements of the individual consumer market.
Payers are realizing that many legacy business processes do not address their evolving needs and new solutions are required to efficiently manage their membership. To keep pace with the changes, progressive health plans are re-tooling critical processes and supporting them with scalable, web-based technologies that satisfy the full spectrum of membership management administration, including marketing, sales, service, and retention.
Genomic medicine – the use of new methods of molecular analysis to better manage a patient’s disease or predisposition to disease – is likely to change the way drugs are developed and medicine is prescribed. Using advanced diagnostic tools, doctors are able to identify specific biological molecular markers and genetic profiles. Using this information in combination with an individual’s medical records and unique circumstances allow doctors and patients to develop individualized prevention and treatment plans for more successful outcomes.
Unlike traditional healthcare delivery that focuses on the treatment of specific diseases across a broad population, personalized medicine treats each patient based on their unique molecular profile, enabling physicians to select therapies that minimize adverse side effects and improve efficacy. Doctors identify molecular markers that signal disease risk or presence before clinical signs and symptoms appear, allowing treatments to focus on prevention and early intervention, rather than on reaction at advanced stages of disease.
Personalized medicine has the potential to change the way we diagnose and treat diseases – but most physicians, payers, patients, and other stakeholders lack the expertise required to incorporate these innovations into traditional care processes.
With major shifts in the healthcare landscape, payors, providers and employers are all looking for ways to lower costs, streamline services and improve health outcomes; all while trying to remain focused on their core businesses. In order to remain competitive, they must find new ways of managing old processes or develop partnerships with companies who offer breakthrough strategies.
These new partners target processes at the core of health business operations and while the processes themselves are not exciting, the savings and opportunities generated makes the heart beat just a little faster.
Economies of scale and connectivity are available with the right credentialing, workers compensation, underwriting, bundled payments and health data intelligence, with the right partners.