Health Care Program Evaluations

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Delivery of health care in America is exceedingly complex. This complexity is the result of fragmented payment systems, technological innovation, an aging population, program integrity efforts, and myriad other factors. Each of these factors adds to the cost of providing health care —for individuals, for employers, and for insurance companies— and to the challenges of providing quality care.

Health care program evaluations can sort through this complexity. IntegrityM is expert at designing and conducting such evaluations. Our evaluations provide health care providers and decision makers with invaluable information about health care operations. Evaluations can focus either on the macro – an entire program or health care system – or the individual – a single practice or procedure. Each evaluation is tailored to our clients’ specific needs. No matter the scope, the outcomes of these evaluations are findings that sort through the complexity to yield understandable conclusions and actionable recommendations that lead to positive change.

As members of Federal Offices of Inspector General – including the U.S. Department of Health and Human Services (HHS) – IntegrityM’s team of experienced evaluators have managed and conducted hundreds of health care evaluations that improved the efficiency and effectiveness of health care programs and yielded billions of dollars in savings through improved operations and the elimination of wasteful spending. IntegrityM’s clients benefit from this experience and expertise. We adhere to all applicable professional standards, such as the Quality Standards for Inspection and Evaluation (the Blue Book) issued by the Council of the Inspectors General on Integrity and Efficiency, in all our evaluation work.

If you would like to discuss how health care program evaluations can benefit you or your program, contact one of our experts today at (703) 683-9600 or fill out our online contact form.

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Health care program evaluation offerings

IntegrityM is expert at conducting various health care program evaluations in both fee-for service and managed care environments, including the following:

  • Medical review – appropriateness or necessity
  • Cross-program payment comparisons – payment policies or reimbursement amounts
  • Compliance with existing program requirements
  • Access to care
  • Quality of care
  • Patient and/or practitioner satisfaction
  • Performance measurement development and assessment
  • Longitudinal program monitoring
  • Program integrity
  • Impact analysis of proposed changes

Our unique approach to health care program evaluations

Our years of experience, especially as managers within the HHS Office of Inspector General, is what sets IntegrityM apart from the competition. We have extensive experience overseeing and working with the Centers for Medicare & Medicaid Services, including all aspects of the Medicare, Medicaid, and Children’s Health Insurance Programs, as well as the other health care agencies within HHS. We also have extensive experience working with State Medicaid programs, both evaluating individual programs and evaluating across programs to compare and contrast States’ efforts to operate the program.

But what also sets us apart is the other disciplines we bring to our evaluation efforts. We have on staff auditors and investigators who have decades of experience auditing and investigating health care financial and compliance matters. We also have a team of doctors, nurses, pharmacists, coders, and analysts who serve as subject matter experts, offering their real-world experiences for the health care program evaluations we conduct.

Contact the health care evaluation experts at IntegrityM

Please contact the health care program evaluation experts at IntegrityM here, or call (703) 683-9600 to speak with someone now.

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