Solutions.

Vision • Clarity • Execution

Effective solutions are created through knowledge and experience. Prospective Strategies guides you through the chaos of constant industry changes in healthcare.

Market Data Solutions Using CMS Public Use Files

CMS regularly publishes more than 130 Public Use Files (PUF) which can be leveraged for research, reference and data analytics. These files contain valuable market information that can provide insights on costs, quality, program enrollment, payer/provider profiles and more.  Since these files are not “research-identifiable”, they do not require any special Data Use Agreement with CMS. The potential for health payers, PBMs and providers to harness this data to extract valuable insights for business is enormous.​

Competitive Market Intelligence

Consolidating competitive information on MAPD benefits, network, enrollment, service area, formulary and Star Ratings — and having it at your fingertips empowers strategic and efficient decision-making. It enables product, sales & marketing, and finance to operate efficiently and cohesively. Streamlining this data enables competitive profiling and benchmarking to inform superior plan offerings:  

• Competitive enrollment and market share
• Competitive network, benefits/formulary and quality
• Demographic profiling across product types
• Star Ratings by plan design, geography, demographics, etc.
• Sales performance analytics

MAPD Benefit, Network and Formulary Design

The MAPD marketplace is highly commoditized and competitive with respect to plan benefits and features. Competition varies by geography and with over 6,000 unique MAPD plans on the market.  Your ability to set benefit design effectively demands data-efficient solutions.

• Outlier analysis for benefits, cost sharing, maximum out-of-pocket
• Formulary coverage, tiering & utilization management protocols
• Medical and pharmacy provider network composition
• Identification of geographic variances
• Analytics for formulary design & rebate strategies

Population Health and Risk Performance

Healthcare payers and providers are increasingly segmenting their populations based on clinical and non-clinical profiles. This enables not only improved clinical care and cost management but also informs marketing campaigns and member communications.

• Clinical & behavioral insights for members with chronic conditions
• Medication Therapy Management (MTM) program design
• Clinical analysis of Star Ratings by geography, demographics & socio-economic factors

Value-Based Care

Sales Pipeline & Target Marketing

Effective value-based care requires a high level of scrutiny and reporting on health cost and quality. New innovative models involve multi-party arrangements which require significant data integration to generate effective data analytics. 

• ACO performance evaluation & partnerships design
• Bundled payment programs (e.g. BPCI- Advanced)
• Payer analysis of value-based provider contracts
  
  

Profiling healthcare entities on revenue, cost performance and quality empowers sales, marketing and M&A due diligence.

• Targeted sales opportunities
• Marketing campaigns
• M&A-related research
• Supply chain analysis (e.g. Part B drugs)
• Hospitals case mix analysis

Wondering where to begin?  
Prospective Strategies can help you explore the possibilities in harvesting this vast amount of data to create effective solutions for your business needs.  As your strategic CMS data consulting partner, we can assist you with structure and design custom solutions that enhance your decision-making abilities. Whether your need is basic analytic solutioning or comprehensive and scalable solutions, we can help.
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Find out more by calling us at 888.503.6550 or emailing us at  info@prospectivestrategies.com