What we do

We operate at the intersection of public policy, business strategy, and government affairs.

Healthsperien’s Tailored and Integrated Offerings Include:

  • Insights into the latest health policy issues impacting people, providers, health plans, and innovators.
  • Impactful solutions to address health care issues across populations, especially those most vulnerable.
  • Partnerships with and for stakeholders to bridge gaps in issue advocacy.
  • HealthsperienX driving innovative approaches and new thinking.

Our Expertise

Centers for Medicare and Medicaid (CMS) and Center for Medicare and Medicaid Innovation (CMMI) Model Education and Implementation, and Engagement

We translate CMS and CMMI model specifications to help our clients understand the participation requirements and enable them to successfully participate in the models. Additionally, we lead ongoing client engagement and collaboration with CMS and CMMI to develop, modify, and refine new and existing models. The models we focus on include, but are not limited to: ACO REACH, Primary Care First (PCF), Seriously Ill Population (SIP), Medicare Shared Savings Program Accountable Care Organizations (ACOs), Next Generation ACOs, Independence at Home (IAH), Medicare Advantage Value-Based Insurance Design (MA V-BID) Demonstration (including the Hospice carve-in).

Advanced, Serious Illness, and Long-Term Services and Supports

We help hospices, palliative care organizations, health systems, non-profits, foundations, patient groups and other stakeholders interested in understanding and improving care for people with advanced and serious illness. We support clients interested in developing and advancing initiatives that help individuals enrolled in Medicaid, people who require long-term services and supports, and others with complex health conditions. Our work supports organizations that provide managed long-term services and support services (MLTSS), developing care models that address social determinants of health and programs to address social isolation and loneliness.
Physician and Provider Strategies

We focus on ways to help physicians, physician groups, not-for-profit hospice programs, behavioral health organizations, health systems, ACOs, ACO REACH (formerly Direct Contracting), PACE programs, and other provider entities be successful in addressing costs and quality, taking on risk, participating in value-based care, and pursuing new initiatives in home-based care. As part of this approach, Healthsperien integrates itself and works collaboratively with clients and their in-house teams to conduct internal & external (e.g., market & landscape) assessments that help identify gaps and opportunities for improvement. We help develop and implement internal and external strategies to influence and address changes in Medicare payment policy, particularly the Quality Payment Program (QPP) and alternative payment models (APMs).

Health Plan Initiatives and Payer Strategies

We support health plan clients and other businesses focused on population health with in-depth regulatory, legislative, and policy analysis. Our services include helping to develop new product, benefit design and insurance/risk strategies for today’s evolving and complex sector. Additionally, we work across our health plan clients’ business units to navigate and advise on the complexities of existing and emerging federal payment programs and demonstrations. We have capabilities and experience in serving commercial payers, Medicare Advantage plans and managed Medicaid health plans.

Value-Based Payment Arrangement Development and Contracting

Healthsperien has extensive experience supporting the development of value-based payment arrangements, from the initial concept to a complete model framework, which includes the following elements: model goals, participant eligibility criteria, patient eligibility criteria, patient attribution/assignment, payment methodology, clinical model specifications, quality measurement, risk adjustment concerns, and waivers. These model frameworks are developed with input and insights from our payer team so that they can then be more easily adapted for engagement and contracting with all payers, including Medicare, Medicaid, and Medicare Advantage plans. We also help facilitate these conversations with payers and other stakeholders, as well as support payer contracting of these models.

Coalition, Communications, and Issue-Based Strategies

Our team helps organizations find other stakeholder partners who have aligned strategic and policy goals as our clients. We offer clients advice and implementation strategies for developing coalitions, frame policy communications and provide customized approaches to legislative and regulatory advocacy, including grassroots and grasstops activation. Coalitions that are our partnered organizations and that we manage include: The National Coalition on Health Care (NCHC), National Partnership for Healthcare and Hospice Innovation (NPHI), National MLTSS Health Plan Association, Smarter Health Care Coalition (SHCC), Coalition to End Social Isolation and Loneliness (CESIL), Foundation for Social Connectedness (F4SC), the Multicancer Early Detection (MCED) Consortium, and the Coalition to Transform Advanced Care (C-TAC).

Innovation and the Future of Health Care

Our team translates evolving research in the clinical, economic, and life sciences arenas into practical ideas for pilots and programs. We help organizations that advocate for patients with behavioral health challenges, chronic conditions, cancer, and other diseases identify ways to leverage research, data, and clinical expertise to support policy goals. We analyze developments in health and economics research and policy think tanks and offer insights to clients about how to leverage evolving research and socialize findings with aligned stakeholders. We identify opportunities for developing business models that incorporate new and evolving technology, such as digital health.

Policy, Economic, and Market Insights

Our team is continuously monitoring and keeping a pulse on the federal public policy regulatory reforms, and developing insights and strategies based on our deep knowledge in a range of subject areas, including Medicare, Medicaid, dual-eligibles, Anti-Kickback Statute & Stark Law, provider workforce, and employer-based and individual health insurance markets. We provide regulatory and policy monitoring to a wide range of clients to help address fast-moving and complex issues, including summaries of proposed and final rules, bill comparisons, analysis of court cases, updates on policy implementation and market developments. We offer strategic insights into health data and provide customized analysis of Medicare and other data sources. We follow developments in health and economics research and policy think tanks and offer insights to clients about how to leverage evolving research.

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