HCSS has extensive national experience which allows for the effective integration of foundational health insurance disciplines. HCSS is able to design the following programs to fit with your strategic platform:

Reporting Systems:
• Design integrated reporting infrastructure
• Research and design actionable healthcare report structures
• Application of “severity” adjusted models
• Design statistically valid benchmark comparisons

Contracting Solutions:
• Cost and quality pay-for-performance models
• Contract negotiations (payer, physicians, and hospitals)
• Contractual performance reporting and reimbursement 

Actuarial / Statistical:
• Pricing Models
• Predict “insured but not reported claims” (IBNR)
• Financial Projections by type of service, disease, age/sex
• Stop-loss reinsurance programs

Reimbursement Programs:
• Develop Per Diem, Per Case, DRG rate structure
• Integrate “severity” adjustments
• Base fee schedule development, comparisons to Medicare

Disease and Quality Management:
• Impact/ROI for programs
• Recommend integrated reporting solutions
• HEDIS reporting systems