Health Plans include large and small healthcare companies serving a several state region, a specific county, or a specified population of enrollees. The health plan may offer only one type of product, such as a Medicaid product, or may offer an array of products that include commercial indemnity, PPO, point-of-service, and managed care products.

The organization's work may be focused on one type of service, such as provider networks, or may encompass a full range of health plan services such as enrollment, benefits design, claims processing, customer service, network contracting, utilization management, and quality assurance and improvement. MCPP consultants have assisted our clients in health plans, both large and small, in improving their operations.

Case Studies: Health Plan

Case Study 1 MCPP assisted a commercial PPO health plan to develop the infrastructure and implement the policies and procedures needed to demonstrate compliance with the State Patient Bill of Rights and with National Committee for Quality Assurance (NCQA) standards. MCPP consultants assisted with the establishment of quality improvement and utilization management programs including appropriate committee structures. In addition, various managers worked with the consultants to develop and then implement policies and procedures to address a variety of issues including confidentiality, enrollee information disclosure, access and availability of services, medical necessity denials, and complaint and appeal processes. Case Study 2 MCPP conducted board and team development projects for a health plan undergoing ownership and leadership transition. The board process included planning and facilitation for the first meeting/retreat of the newly merged board as well as subsequent annual board retreats. The separate senior management and divisional team development processes included an assessment of needs, consulting with senior leadership or managers, off-site retreats, and follow-up meetings to address outstanding issues.