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TPA | Community Health System Start-Up

For several years there has been a transition occurring in the Plan Administration industry where focus is shifting from management of “transactions” (claims and phone calls) to management of the covered patient.  This has opened up tremendous opportunities for investment in TPAs able to deliver the re-focused services and for health care players (hospitals and physician groups) to develop Community Health Systems in their local and regional markets.

MCS has significant experience, tools and resources to facilitate development of the new models using World Class principles.  This includes recently building a $10 Million TPA for investors from the ground up and consulting with several health care entities on different variations of the Community Health System model.  MCS is able to assist with the following aspects of start-up:

  • Development and fine tuning of Business Plans;

  • Staffing models and search for qualified and experienced managers;

  • Network development and oversight assistance;

  • Marketing and sales plans, including distribution strategies;

  • Population Health program development and “build vs. buy” decisions;

  • Technology acquisition and data retention and use standards;

  • Operational workflows and metrics for performance;

  • Staff training; and

  • Development of internal and client reporting and analytics.

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