Anyone who has spent any time in healthcare recognizes the significant differences between private and public payers. SCIOinspire has dedicated specific resources to ensure its solutions address the specific needs of Medicare and Medicaid plans through care management, other-party liability, audit and recovery for high-cost pharmaceuticals and implantable devices, and process improvement services.
SCIOinspire is an industry leader in dual eligibles, having developed an analytical database that integrates Medicare with Medicaid databases.
With decades of experience in the private sector and a deep understanding of the challenges facing public programs, SCIOinspire is in a unique position to combine best practices from each environment to develop innovative initiatives and highly successful solutions.
Medicare
Governed by complex and variable federal regulations, Medicare contractors are compelled to manage claims and costs rigorously. This will become even more challenging as the American Baby Boomer ages and demands on resources increase.
Pain Points
Medicare contractors are challenged with:
- Escalating costs due to rising numbers of beneficiaries, increasing acuity
- Shrinking resources
- Identifying, pursuing subrogation claims
- Need to enhance audit capabilities for E&M, costly specialty services
- Growing incidence of fraud, abuse
Value Proposition
SCIOinspire is highly regarded for its:
- Wellness, care management solutions tailored to specific segments of the Medicare population
- Proven expertise in Medicare third-party liability requirements
- Effective audit and recovery solutions in high-cost pharmaceuticals, implantable devices and E&M services
- Robust technology platforms delivered via software-as-a-service (SaaS) or for internal hosting
- Business process consulting and services
- Flexible delivery models including in-, co- and outsourcing to optimize resources
Medicaid
The need for enhanced performance is particularly acute with Medicaid programs, which are experiencing a sharp rise in the number of beneficiaries and a corresponding increase in costs. In addition, the variation from state to state requires a wide network of resources and deep domain expertise in the issues facing individual Medicaid programs.
Pain Points
Medicaid programs face the challenges of:
- Increase in the unemployed and indigent population
- Rising demand for management of multiple, severe, costly chronic conditions
- Subrogating claims in accordance with regulatory and legal restrictions
- Need to enhance audit capabilities for E&M, costly specialty services
- Demand for improvements in efficiency, effectiveness
Value Proposition
SCIOinspire offers:
- In-house counsel and paralegals, as well as a national network of attorneys with state-by-state regulatory expertise, for third-party liability recovery
- Applications and business process solutions to improve care management efforts
- Customizable data analytics to evaluate performance
- Effective audit and recovery solutions in high-cost pharmaceuticals, implantable devices and E&M services
- Robust technology platforms delivered via software as a service (SaaS) or for internal hosting
