Healthcare Payer Consulting

Healthcare payer solutions to increase profitability and improve quality of care

Home Healthcare Healthcare Payer Consulting

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

Improve profitability across all payer lines of business

Network
Solutions

Optimize provider networks for increased access

Quality Improvement & Member Satisfaction

Strengthen member experience and network quality

Operational Improvement
& Healthcare Tech

Modernize operations for measurable results at scale


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:

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:


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.

Click here to directly submit an RFP.

Our Healthcare Payer Consulting Leadership

View Bio
Jackie Ferguson
Managing Director
View Bio
Mark O’Hara
Managing Director
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Duane Harrington
Senior Managing Director