Health Plan Financial Management Services
Cirdan simplifies starting and maintaining plans by giving you access to comprehensive health plan consulting and financial management services. From short-term projects and staff augmentation to long-term roles in financial management such as serving as a plan CFO, we can help.
Cirdan has the financial expertise needed to start and manage an ongoing health plan organization. Whether it’s financial planning, analysis, management, or reporting, our health care consultants can guide you through it.
Support for Health Plan Feasibility Evaluation
We help organizations evaluate the financial feasibility of creating a health plan. This includes creating forecasts for enrollment, revenue, claim and administrative expenses, and projections of the capital they’ll need to start a plan.
Support for Health Plan Licensure Process
We prepare the “orange” health blank annual statutory statements required by the National Association of Insurance Commissioners (NAIC) for healthcare plans. We also prepare the related quarterly filings.
Statutory Reporting
Cirdan prepares the “orange” health blank annual statutory statements required by the National Association of Insurance Commissioners (NAIC) for health plans. We also prepare the related quarterly filings.
Budgeting and Forecasting
Cirdan prepares annual projections of enrollment, claims, and revenue for clients. We have developed custom tools to help our clients model changes in enrollment, expected medical costs or utilization, and risk scores to understand their impact on expected financial results.
Management Reporting
Cirdan prepares custom reporting to meet the needs of management teams and health plan boards. This can be done routinely, or for specific initiatives. Cirdan also helps health plans understand their emerging financial experience, and results once claims are fully developed and all financial settlements are finalized.
Financial Controls and Accounting
Cirdan assists clients with a full range of services including management of accounting, banking, policies, and procedures. We also provide individualized support for unique financial projects.
Risk-Based Capital Modeling
Cirdan’s clients occasionally have opportunities for growth in new product markets or expansions of geographic regions. Cirdan assists by modeling the impact of growth scenarios on risk-based capital.
Other Regulatory Reporting
Cirdan prepares custom reporting to meet regulatory requirements. Examples include submission of financial data on the experience of Medicaid members, state-specific supplemental statutory reports, and reporting required by state health agencies.
HEDIS
The Healthcare Effectiveness Data and Information Set (HEDIS) was designed to allow consumers and regulators to compare health plan performance between plans and to national or regional benchmarks. CMS requires health plans participating in the Medicare Advantage program to submit Medicare HEDIS data. CMS’s Five Star Quality Rating System is determined by performance on measures taken from five different rating systems, including HEDIS. The Patient Protection and Affordable Care Act of 2010 (PPACA) essentially ties federal reimbursement rates to plan performance, as measured by the “Stars” rating system. Cirdan’s experienced actuaries and data professionals can help improve your HEDIS data and submission process. We can assist with preparation of data for HEDIS software, sampling for chart reviews, HEDIS report preparation, Compliance Audit Support and Health Outcomes Survey Support.