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 Medicare & other government-sponsored health plans, as well as 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
All U.S. markets
& lines of business
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:
Cost of Care
General & Administrative Costs
Revenue Optimization & Growth
- Product Growth Strategy & Market Expansion
- New Product Implementation Support
- Member Attrition & Retention Strategy
- Risk Adjustment & Encounters Advisory
- Revenue Reconciliation & Accuracy
Payment Intelligence®
Ensuring accurate payment of medical claims is crucial for health plans, navigating a complex web of contractual and regulatory requirements that extend beyond traditional payment integrity. AArete Payment Intelligence® offers an innovative solution developed from extensive Payer experience. By leveraging machine learning and artificial intelligence, our solution is tailored to meet the needs of your plan and seamlessly adapt to evolving industry requirements.
AArete addresses the cause of claims issues, reducing their recurrence and establishing smarter and more efficient processes. By addressing underlying problems, AArete helps you save time and money and ensures greater accuracy in payments, ultimately enhancing overall operational efficiency.
How We Can Help:
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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:
- AI Solutions for Healthcare Payers
- Intelligent Contract Interpretation with Doczy.ai™
- Systems Integration & Migration Support
- Process & Productivity Improvement
- Cybersecurity
- Data & Analytics
- Pega® Optimization & Workforce Development
AArete is HITRUST Certified
AArete is pleased to demonstrate to our clients the highest standards for data protection and information security by achieving the rigorous HITRUST Risk-based, 2-year Certification for the information technology infrastructure running within Amazon Web Services (AWS) and Snowflake platforms. This achievement places AArete in an elite group of organizations worldwide that have earned this certification. HITRUST Certification is globally recognized as the gold standard and validation that information security and privacy controls are effective and compliant with various regulations.
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.
