As complex economic and regulatory pressures and digital disruption continue to impact payer performance, critical health outcomes are at stake. AArete’s healthcare payer consulting integrates extensive business, clinical, and technical expertise across the full spectrum of payer operations to help clients improve their profitability and productivity while realizing their care management goals. We serve government-sponsored and commercial health plans of all sizes by designing and implementing end-to-end solutions that balance costs and revenue impact, manage risk, and improve quality of care.
Health Plan Consulting Expertise
The breadth and depth of our market intelligence is derived from robust healthcare data including claims, policies, encounters, contracts, and other data. Our approach is personal and customized: we lead the development of industry best practices while prioritizing the unique set of challenges faced by each health plan.
120+
health plans
9 of the
top 10 plans*
All U.S. markets
& lines of business
*Based on at-risk membership
The AArete Difference
Market
Intelligence
Data-Driven
Strategies
We
Implement
Our Healthcare Payer Solutions
Data analytics, proprietary market intelligence, proven methodologies, and advanced technology allow us to rapidly identify and implement measurable solutions. Our healthcare payer solutions are designed to decrease your overall expenses while improving your health plan’s operational efficiency, claims accuracy, and quality of care.
Featured Services
Click “Explore” to learn more about each of our featured services.
Cost Management & Revenue Optimization
AArete provides a comprehensive, data-driven approach to maximize profitability while ensuring high-quality care through medical cost and G&A (General & Administrative) cost management. With expertise in claims, provider and vendor contracts, policies, utilization management and unit costs alongside G&A cost analyses, AArete leverages market intelligence to identify cost savings across all payer lines of business.
We can help with:
Medical Costs
General & Administrative Costs
- Vendor Costs
- Productivity Improvement
Revenue Optimization & Growth
- Product Growth Strategy & Market Expansion
- New Product Implementation Support
- Member Attrition & Retention Strategy
- Risk Adjustment & Encounters Advisory
- Revenue Reconciliation & Accuracy
Network Solutions
AArete helps payers identify and capture opportunities to ensure your network is meeting your objectives, helping meet your health plan’s specific goals, including but not limited to becoming more competitive, creating an access advantage, increase provider engagement, or improved quality of services and experiences for your members.
How we can help:
Quality Improvement & Member Satisfaction
AArete offers a comprehensive suite of services to improve your health plan’s quality management performance. Whether you’re looking to increase Medicare Star ratings, improve HEDIS and CAHPS performance, boost patient outcomes, or enhance your organization’s reporting capabilities, AArete’s data-driven approach and deep market understanding can help you achieve your organization’s quality program goals.
How we can help:
Operational Improvement & Healthcare Tech
Healthcare payers must integrate business and technology strategy to improve operational efficiency and scale. Whether your goals are to modernize member experiences, to harness the power of data and analytics to improve decision-making, to ensure a successful systems migration project, or to assess your cybersecurity strategy and resilience – AArete has deep business acumen and technology expertise to help you achieve those goals.
How we can help:
- Process & Productivity Improvement
- Systems Integration & Migration Support
- Cybersecurity
- Data & Analytics
Our Healthcare Payer Insights
Let’s Talk
Whether you’re looking for a consulting partner who can adapt to your health plan’s specific needs and drive results, or just curious about our services and solutions, let’s talk.
Our Healthcare Payer Consulting Leadership
Jackie Ferguson
Expertise Areas:
Jackie Ferguson
Jackie is a Managing Director and co-leader of AArete’s Healthcare Payer practice. In this role, Jackie serves payer clients with solutions including strategic profitability improvement, medical management, network solutions, pharmacy, and digital and technology services. She has consulted across a wide range of industries including Health Payer, Financial Services, Retail and Consumer, and Education. Jackie holds a BBA degree from Saint Mary’s College and has an Executive MBA degree from the University of Notre Dame. She is a member of Women Business Leaders of the U.S. Healthcare Industry Foundation (WBL) and is an Executive Sponsor of AArete’s Women’s Initiative Network (WIN).
Mark O’Hara
Expertise Areas:
Mark O’Hara
Mark is a Managing Director and co-leader of AArete’s Healthcare Payer Practice. He is responsible for the overall strategic vision and execution of AArete’s solutions for Payer clients. He has extensive expertise leading a variety of engagements including medical and administrative cost reduction, process improvement, network development, M&A and others. Mark has worked with payer clients for over 20 years, providing a wealth of experience to his clients.
Mark holds a Master of Business Administration degree from Cornell University, a Bachelor of Arts degree from Washington University in St. Louis, and is a published author in CFO Magazine.
Duane Harrington
Expertise Areas:
Duane Harrington
Duane brings more than 25 years of consulting experience helping organizations with various strategy, performance improvement and operational initiatives. As part of AArete’s Executive Leadership, Duane works closely with our industry and service line leads to drive growth while supporting innovation and solution development. Duane holds a Master of Business Administration degree from Northwestern University’s Kellogg School of Management and a Bachelor of Business Administration degree from The Ohio State University.