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Visit our download page for access to all of our documentation regarding Health Insurance

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Downloads

Visit our download page for access to all of our documentation regarding Health Insurance

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Health Insurance

Today’s ever-changing business environment requires organizations to continuously adapt to technological changes, industry consolidations, governmental regulations, cost pressures. and changes in the how and where care is delivered. In the healthcare and payor (i.e., health plans) sectors, these changes are moving at an accelerated rate and being able to make sense of these changes is a specialty of John Kim & Associates (JKA). At JKA, we have a proven track record of success working with health plans spanning several industry sectors including:

  • Commercial (Self-Funded and Fully-Funded)
  • Medicare (Medicare Advantage and Medicare Supplement)
  • State (Medicaid) and Government (Military) Programs

Focusing on designing the ‘right’ strategy to help each segment achieve their strategic, business, and operational objectives is the key. JKA’s strengths include:

  • Innovative solutions with shared risk and capitation agreements with health systems and practices
  • Development of growth strategies while improving Medical Loss Ratios (MLRs) and Med Expense
  • Reduction and leverage of administrative costs
  • Breakthrough improvements in medical expense and MLR

Working in a health plan operations groups and using our proprietary approach to improving the flow of information (Value Stream Mapping for information (VSMi®), we identify and improve the ‘right’ processes that to drive improvements in areas such as enrollment, underwriting, claims, member services, case management, utilization management, sales, and compliance. It is this targeted approach that enables us to impact the health plan’s financials (Income Statement and/or Balance Sheet) including:

  • Sales (Revenue)
  • Marketing (Market Share)
  • Medical Expense (MLR)
  • Administrative Expense
  • IT Infrastructure and Cost
  • New Product Development/New Product Introduction
  • Medicare Risk Adjustments (Revenue)