Hospitals & Provider Groups

We provide a wide range of services to the healthcare provider groups and to hospitals. When we use the term provider groups, we are including all types of entities including IPAs, PHOs, MSOs, PPOs, utilization review firms, managed care carve-outs and tertiary care plans. Our experience is that each type of entity will have its own needs and may require customized solutions in order to achieve their goals.

In our discussion with various managed care providers and hospital organizations, we have found an immediate need for solutions in the following areas:

• New product development, partnership selection, insurance licensing and reinsurance risk management services for hospital organizations and provider groups interested in entering the insurance market.
• Human resource support to assist both hospital and provider groups with their own benefit plans including health, life, disability coverage, flexible benefits pricing and stop loss insurance.
• Provider groups assuming risk from health plans and HMOs will need analysis of data, actuarial support, reinsurance and negotiation experience.

Hospitals and provider groups negotiate contracts with HMOs and health plans have many challenges. A critical area includes assessing the value of their contracts and the reliability of their underlying data. We provide this expertise to our clients and offer additional actuarial support in the negotiation process. We will analyze our client’s risk profile and work with them in establishing appropriate risk management procedures including data analysis, reporting, capital management and reinsurance.

With the reduction in the number of HMOs and insurance companies writing health insurance, we have seen a void in the market place for available health plans. Hospitals and provider groups have been looking to enter this market. These organizations will need to develop the critical insurance infrastructure so that they can offer various products, or find a partner. Functions needed would include marketing, sales, underwriting, claims, accounting, compliance and actuarial services as well as solve the need for an insurance company license and reinsurance support. We have significant expertise in these areas and can provide the solutions necessary to help our clients develop their own plan and tailor it to meet their unique objectives.

In addition to providing health care to its customers and potentially establishing its own insurance based health care plan to attract future revenues, hospitals and provider groups are challenged with the needs of their own employees. We can provide your Human Resources department with the expertise to manage your own benefit programs including assisting in the plan design review, reserve analysis and COBRA premium development, especially companies with self-funded plans whereby the entity is assuming the risk. Other services that we offer include evaluation and selection of third party administrators (claims payer) and further claims management and cost containment (e.g., tertiary networks or network expansion).

For additional details pertaining to services offered, please review the Services section of our website and then contact us at 914-933-0063 or e-mail us at Michael.Frank@AquariusCapital.com.