Consulting services designed for payer and provider transformation
Each engagement is structured to produce measurable outcomes while keeping execution practical for internal teams.
Quick Wins Analysis
A 30-day, fixed-fee diagnostic — the fastest way to see whether there's meaningful, defensible capture opportunity in your population.
You send a de-identified claims and HCC capture extract. I run it through AI-accelerated analysis — pattern-finding and prioritization across your population at the data level — and return a prioritized opportunity list, tiered by likelihood and ease of valid capture, with PMPM impact estimates, implementation-effort scores, and clinical and operational next steps. The analysis is fast; the judgment is mine — every conclusion is reviewed before it reaches you. It stands on its own — even if the engagement ends at day 30, your team has an actionable list for the current performance year.
Tiers I surface
- Tier 1 — Active members, lapsed captures. Frequent PCP visits, historical HCC captures not recaptured last year. The care pathway already exists; documentation and coding just need to be activated.
- Tier 2 — Inactive members, lapsed captures. Same historical evidence, but the member isn't coming in — needs targeted outreach, AWV programs, in-home assessments.
- Tier 3 — Suspect populations. Infrequent visits, low documented HCC counts, high claims costs — real disease burden that isn't being captured. Hardest tier, highest unit value.
Risk Adjustment Strategy
Assess your current-state program and prioritize the highest-impact interventions across coding, documentation, and analytics.
Ideal for
Payers and provider groups needing a sharper strategy before annual planning, RADV prep, or market expansion.
Likely Outcomes
- Clear roadmap tied to RAF and quality goals
- Prioritized intervention backlog by ROI
- Executive-ready performance scorecard
Core Deliverables
- Program maturity assessment
- 12-month strategic roadmap
- Leadership KPI dashboard design
Program Effectiveness Reviews
Identify where your risk-adjustment workflows break down and implement practical fixes across operations and partner performance.
Ideal for
Organizations with fragmented processes, inconsistent coding lift, or unclear accountability across teams.
Likely Outcomes
- Improved documentation and coding consistency
- Reduced leakage in suspecting and recapture
- Defined ownership model across teams
Core Deliverables
- Workflow and gap analysis
- Role-based operating model recommendations
- 90-day execution plan
Value-Based Performance Enablement
Align risk-adjustment strategy with value-based care objectives so providers, market leaders, and analytics teams execute from one plan.
Ideal for
Payers and payviders trying to close care gaps while improving coding performance and provider engagement.
Likely Outcomes
- Higher provider participation in value-based activities
- Better alignment between care and coding workflows
- Operational clarity across quality and risk programs
Core Deliverables
- Provider enablement framework
- Joint risk-quality action plan
- Performance governance cadence
Operating Model Transformation
Restructure teams, vendor oversight, and reporting rhythms to scale risk-adjusted performance across regions and lines of business.
Ideal for
Growing plans and provider organizations preparing for expansion, integration, or significant vendor transitions.
Likely Outcomes
- Faster decision-making across leaders
- Stronger vendor and partner accountability
- Repeatable playbooks for new markets
Core Deliverables
- Target operating model
- Governance and escalation design
- Implementation support playbook
Want a recommendation on where to start?
I can evaluate your current state and recommend the highest-priority workstream in a single strategy session.