SOLUTIONS
As U.S. healthcare adapts to the rising cost of care, our clients face increasingly complex clinical and financial risk. At Stoddard Group, the acuity and dimension of our insights unlock unique opportunities to optimize financial performance, reduce inefficiency, and improve overall healthcare value.
Risk Adjustment Solutions
Our Risk Adjustment suite includes complete retrospective risk adjustment solutions supported by technology, analytics, artificial intelligence, and deep subject-matter expertise. We are committed to ensuring that plans are appropriately reimbursed to manage and coordinate care for their members.
Risk adjustment programs are complex, and their successful management requires maintaining complete compliance while ensuring your health plan’s risk burden is appropriately documented in medical records and encounter submissions. Knowing which risk adjustment tools to use—and when to use them—is critical to ensuring timely and consistent revenue payments. In addition, the regulatory environment changes frequently, and government audits are becoming more common. The stakes are high. You need a partner with extensive risk adjustment experience, one that you can depend on and trust.
Payment Policy Management
The healthcare ecosystem faces enormous pressure to develop, operate, and maintain expansive infrastructure to continually improve healthcare accessibility and quality. At the same time, complex U.S. healthcare billing and payment processes pressure physicians to be expert medical practitioners and payers to perfect hundreds of functions and processes. The cost and time to develop the expertise in one of those functions, such as payment integrity, can overwhelm payers. And with the vast network of physicians caring for plan members’ individual needs, staying current with ever-evolving claims payment policy changes is difficult. Our unique insights leverage extensive reference assets and clinical research acumen to help us identify potential payment vulnerabilities and develop industry-compliant, effective payment rules. And our comprehensive policy recommendations apply across all provider settings and lines of business.
Quality & Performance
As value-based reimbursement becomes the standard, our Quality and Performance solutions allow health plans to move from simply reporting quality measures to driving the purchase, delivery, and utilization of higher value healthcare. Our solutions enable health plans to collaborate more effectively with their provider networks, with members, and with other functional teams within the plan itself. The result? Plans can successfully manage members’ clinical and financial risks, make the most of limited internal resources, and stay compliant with industry requirements and regulations.
Contract Compliance
Healthcare claims must be quickly and accurately reimbursed according to differing provider contractual terms, prompt pay laws, and other state regulations. At the same time, payers must keep data safe and in compliance with all regulatory mandates such as HIPAA, HITECH, and SOC. Our Contract Compliance solution enhances accuracy in the application of liability, coverage, and payment terms for contracted agreements. Our healthcare claim accuracy experts use proprietary analytics and data-mining tools to find overpayments that might otherwise go undetected. We work with our payer clients to configure claim reviews specific to relevant regulation and contracted policy. When we identify an error, we provide clients with full details and supporting documentation, then work closely with them to facilitate recovery—all with minimum disruption to providers and network relationships.
Staffing Solutions
As a leading professional services firm specializing in consulting, staffing and recruiting, and executive search, Stoddard Group delivers the expertise and talent companies need to achieve and sustain business growth. We offer a full suite of consulting and recruiting capabilities- with a growing network of companies, offices across the United States, and deep relationships in regional and local markets, Stoddard Group is quickly becoming one of the top staffing agencies in the US providing industry-leading expertise with a national reach and a localized touch.
Reshaping the economics of healthcare
We’re focused on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality.
Operating at peak efficiency requires honest assessment of improvement opportunities. When you can depend on the information you receive, and the people from whom you receive it, you can make the smartest decisions and encourage the best type of collaboration—both within your organization and with all of its stakeholders.
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Payers
Commercial, Medicare, and Medicaid lines of business all face unique challenges in a rapidly changing market. The key to success, however, remains constant: smart decisions based on sound data. Whether you want to improve payment accuracy, risk adjustment, care quality, or network performance, we have the most complete set of solutions to meet your needs, backed by decades of experience and our passionate commitment to your success.
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Providers
Provider organizations have moved steadily into value-based healthcare delivery and payment programs. However, successful risk management is as challenging as it is essential.
Our performance analytics solutions help provider organizations understand and mitigate clinical and financial risks, delivering the insights needed to design and refine high-impact population health strategies. Our track record of success in managing multi-payer claim sets and other clinical data allows accountable care organizations and other risk-bearing providers to create a true longitudinal record across many settings of care to make better, data-driven decisions.
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Government
Government agencies, in particular the Centers for Medicare & Medicaid Services (CMS), face unique challenges measuring and managing healthcare quality; optimizing risk adjustment programs; and preventing fraud, waste, and abuse. The United States wastes nearly $1 trillion annually on healthcare spending—an estimated $600 billion of which can be attributed to unnecessary care and other inappropriate payments.