CLIENT: Provider of advanced technology for enhanced editing of health care provider (non-facility) claims, workflow streamlining, and SG&A cost reduction. We began working with this company as it was being formed in 1999 and are still selling their services on behalf of the company that acquired them in 2005.
ACHIEVEMENTS: Obtained key contracts with leading national and regional health-care payers and developed large national account pipeline. Positioned company for expansion funding and acquisition by the subsidiary of a Fortune 15 company, considered the industry "standard" in this space.
CLIENT: Care management company specializing in disease management, post-acute care management, complex care management, geriatric care manager networks, and utilization management.
ACHIEVEMENTS: Obtained and implemented large healthcare payer contracts that multiplied revenues numerous times during our 8-year relationship; created and provided executive management for a new operations region required to support contracts we arranged; wrote a successful NY Medicaid proposal that helped demonstrate the success of the Medical Home concept; were successful in creating sales momentum sufficient to drive $30 million in expansion funding and ultimately positioned our client for merger with a public company.
CLIENT: Physician practice, specialty carve-out management services organization and technology developer.
ACHIEVEMENTS: Developed state-wide specialty physician networks in cardiology and orthopedic surgery in NY, NJ, PA, CT and DE and guided the networks' development of best practices, clinical pathways and performance-based reimbursement models. Retained by the Management Services Organization hired to support these networks, and obtained exclusive contracts with regional health-care payers to generate initial revenues positioning the company for a $120 million IPO.
CLIENT: Developer/provider of a service using the first FDA-cleared device for virtually attended, at-home diagnosis of obstructive sleep apnea, and provider of full-service sleep management programs.
ACHIEVEMENTS: Helped redefine company's business model from manufacturer-to-physician device sales without insurance coverage, to become a Managed Care Services company providing a comprehensive sleep management programs for payers that integrated Obstructive Sleep Apnea (OSA) screening, testing, CPAP therapy, and patient compliance support to provide an end-to-end sleep management solution. Guided the establishment of new non-manufacturing operations capabilities to support the new solution. Provided sales stability and consistency through three management reorganizations, obtaining key initial and subsequent Managed Care contracts that generated sales and revenue momentum to drive two additional $20M funding rounds.
CLIENT: Developer/provider of first FDA-cleared device for the definitive diagnosis and medication therapy management of Attention Deficit Hyperactivity Disorder (ADHD).
ACHIEVEMENTS: Provided market segmentation advice and conducted initial payer reconnaissance to assess processes and time frames for healthcare payer reimbursement as a critical component of the company's product/service launch plan. Designed and executed the company's Managed Care contracting and reimbursement strategy, as well as supporting their provider strategy. Based on our market reconnaissance, we recommended our client pursue a provider-focused sales strategy rather than a Managed Care strategy, which has been a successful strategy to date.
CLIENT: Provider of an advanced comprehensive facility claim auditing and recovery service for health care payers that uses data analytics and hands-on auditing of claims around facility episodes of care. The client identifies recoverable overpayments to hospitals and other facilities and conducts root cause analysis identifying the underlying causes of such overpayments. Based on the findings, payers adjust their adjudication systems and contracting methodology preventing similar overpayments in the future.
ACHIEVEMENTS: Successfully redefined and differentiated the company's niche in the highly competitive healthcare facility claims auditing field. Obtained numerous initial and subsequent contracts with large national and regional healthcare payers that have significantly increased our client's revenues and market profile.
CLIENT: Remote Patient Monitoring logistics support company with over 20 years experience providing Vital Signs Monitoring for chronic disease management and hospital admission/readmission prevention; monitored medication dispensing with reminder calls to promote higher medication adherence and reduce hospitalizations related to non-adherence; and Personal Emergency Response System (PERS) monitoring to help maintain a safe environment for Long-Term Care at home.
ACHIEVEMENTS: Conducted market reconnaissance that confirmed our client's belief that Managed Care Organizations could open an additional market to supplement its consumer business base; guided development and implementation of policies and procedures to support Managed Care contracts; defined payer-responsive contracting and a reimbursement model that enables our client's customers to allocate our client's payments as medical claim expense rather than a overhead expense; guided development of Managed Care reporting and account management capabilities; and obtained key contracts with national and regional Managed Care payers now comprising 10% of the company's total revenues, projected to increase 400% in year 2012.
CLIENT: A pioneer in the rapidly expanding field of advanced illness/end of life services, focusing on improving the quality of life for health plan members while reducing unnecessary and unwanted hospitalizations and other high cost medical interventions at the end of life.
ACHIEVEMENTS: Revamped the company's messaging and contracting practices to become market driven. Obtained key contracts with regional and national health plans during the first year of engagement. Increased company revenues five-fold compared to the prior year. The company's sales pipeline is filled with additional marquee prospects as the demand for the company's market-driven services continues to grow.