What we do
We operate at the intersection of public policy, business strategy, and government affairs.
Healthsperien’s Tailored and Integrated Services Include:
- Providing Insights into the latest health policy issues impacting people, providers, health plans, and innovators.
- Delivering Impactful solutions to address health care issues across populations, especially those most vulnerable.
- Building Partnerships with and for stakeholders to bridge gaps in issue advocacy.
- Driving Innovation through and new thinking through HealthsperienX.
Healthsperien works with an array of Fortune 500, community-based, and national, not-for-profit organizations. Our clients include health plans and care providers, stakeholder coalitions, organizations focused on payment and delivery reform, and others interested in more effective use of technology and data and analytics. Clients look to us for tailored and integrated services that include:
- Building and managing coalitions, partnerships, and alliances, convening expert meetings, and leading and sustaining legislative and regulatory advocacy and communications efforts for a range of industry and non- profit organizations, specifically employer purchasers, health plans and providers;
- Designing and developing alternative payment models and other approaches to improving care delivery and advancing value-based payment and quality measurement in the private sector and in government programs, such as those run by the Center for Medicare & Medicaid Innovation;
- Developing regulatory insights and strategy based on our deep knowledge in a range of subject areas in public policy and the health care sector, including Medicare, Medicaid and employer-based and individual health insurance markets; and
- Providing expertise in economic and policy analysis, health services research, clinical analytics, risk adjustment, and actuarial models to enhance perspectives about the health care sector and inform business strategy and advocacy.
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 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.
Mental Health Care Innovation
Our team is deeply immersed in the critical mental health issues facing individuals and the delivery system. We are particularly focused on socializing key topics with policymakers and interested stakeholders to further development, coverage, and access to innovative treatments to address the nation’s most pressing mental health needs, including treatment resistant depression. As well, our work spans across communities with particular attention to bridging gaps for youth and other vulnerable populations. We partner with our clients to develop and execute comprehensive engagement strategies.
Public Health, Social Service, and Health Equity Strategies
Our team draws from various backgrounds and experiences navigating the broad array of public health and social services systems that intersect with health care providers, systems, and payers. Our public health backgrounds include mental and behavioral health, maternal and child wellness, health disparities and population health, pandemic planning and capacity building, and cancer and chronic disease prevention, including global efforts in those areas. Related insights in housing, mobility, nutrition, supported by deep knowledge of federal agencies and state government capabilities, help us advance innovative work in this area. Our international relationships, with the World Health Organization (WHO), European Commission Joint Research Center (JRC), and the Global Initiative on Loneliness and Isolation (GILC), strengthen our work in multiple areas. We provide regulatory and policy monitoring and analysis, as well as strategic and programmatic development, to a wide range of clients serving the most vulnerable communities across the US and globally.
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, research, and policy goals to build new partnerships and coalitions. We have expertise in implementation strategies to develop coalitions and partnerships, frame policy and research communications, and provide customized approaches to legislative and regulatory advocacy, including grassroots and grasstops activation. Some notable organizations that our team members provide contract-based advice, services, and management support include but are not limited to The Multicancer Early Detection Consortium (MCED), National Partnership for Healthcare and Hospice Innovation (NPHI), National MLTSS Health Plan Association, Smarter Health Care Coalition (SHCC), and the Coalition to Transform Advanced Care (C-TAC).
Innovation, Life Sciences, Technology, and the Future of Health Care
Policy, Economic, and Market Insights