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ProspHire Earns Spot on the Inc. 5000 List for 3rd Consecutive Year  

PITTSBURGH, PA – ProspHire announced today that it has been named #3337 on Inc. Magazine’s annual list of America’s Fastest-Growing Private Companies – the Inc. 5000. The rank reveal also put ProspHire at #14 in Pittsburgh, #84 in Pennsylvania and #330 in the nation for business products and services. The list represents a unique look at the most successful companies within the U.S. economy’s most dynamic segment – independent, small businesses. ProspHire, a national healthcare consulting firm, is recognized for its revenue growth. 

“We are honored to be included on this prestigious list of the nation’s fastest-growing private companies for a third consecutive year,” said Lauren Miladinovich, Managing Principal and CEO of ProspHire. “This demonstrates our continued commitment to excellence as we navigate some of the toughest challenges our firm has ever faced. Our team remains focused on bringing deep healthcare industry knowledge and exceptional service to every client.”  

The companies on the 2022 Inc. 5000 have not only been successful but also demonstrated resilience amid supply chain issues, the labor shortage and ongoing impact of COVID-19.  

Chris Miladinovich, ProspHire’s Principal and COO, said, “The last few years have been volatile for small businesses like our Firm, so to be recognized 3 years in a row as an Inc. 5000 Fastest Growing Company is an absolute honor. We’ve had double digit growth year over year since our founding, which is a direct result of the amazing work of our employees and the partnerships with our clients. It proves our model for growth is thriving even through unprecedented economic times.”  

“The accomplishment of building one of the fastest-growing companies in the U.S. cannot be overstated,” says Dan Crogan, Principal and SVP of Consulting. “It validates ProspHire’s leadership team and our employees who work tirelessly on behalf of our clients. Our success and continued growth in this highly competitive and demanding healthcare industry is a testament to that hard work and to our wonderful clients with whom we’ve been able to Prosper Together over the years.”  

Complete results of the Inc, 5000, including company profiles and an interactive database that can be sorted by industry, region, and other criteria can be found at  

About ProspHire 

ProspHire is a national management consulting firm focused on healthcare advisory, project delivery and strategic sourcing. Founded on the core value of relationships, with the goal to “prosper together”, ProspHire partners with clients to identify and solve their most significant people, process and technology challenges. The women-owned and rapidly growing Pittsburgh-based firm has nearly a 100 dedicated practitioners and consultants who deliver on projects and services across the U.S.  

What’s the Difference Between Mergers and Acquisitions in Healthcare?

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Healthcare payers are constantly looking for ways to reduce or improve costs. One way to do that is to acquire another company in the healthcare industry or join with another payer.

If your organization is looking for ways to grow and improve, you might consider merging with or acquiring another. Learn more about the difference between mergers and acquisitions, the benefits of each and how to successfully navigate one or the other.

What Is an Acquisition in Healthcare?

During an acquisition, one healthcare organization gains control of another. For example, one insurer could acquire another to increase membership or enter a new market with enhanced products and services. Though larger companies typically buy up smaller ones, in some cases, one insurer might purchase another similarly sized one.

Following an acquisition, the purchasing organization takes over the operations of the practice it bought, often changing the hiring policies, operating hours and HR standards.

A healthcare payer might decide to purchase another payer or service provider for various reasons.

  • To start offering a new service: Acquiring a company that offers a service related to healthcare, such as a telehealth network, allows a payer to offer a new service to patients. If an insurer acquires a telehealth vendor, it can direct members to that vendor, reducing its healthcare costs.
  • To increase its member base: Acquiring another healthcare payer allows the first payer organization to expand the size of its member base. For example, if a larger insurer purchases another, it gets access to the acquired payer’s members.
  • To reduce costs: An acquisition can be a cost-cutting move, as well. An organization can purchase a company that produces specific types of medical equipment or offers certain services, reducing its expenses in that department.
  • To expand geographically: Acquiring another insurer allows a healthcare payer to increase its geographic footprint. For example, a New York-based insurer can purchase a payer based in Philadelphia, allowing it to expand into another regional market.

Acquisitions can be friendly or hostile. During a friendly acquisition, the two companies cooperate throughout the process. The organization’s leadership team has accepted the offer and given their approval.

During a hostile acquisition, the management of the acquired organization isn’t in favor of the purchase. The management team might reject the offer from the acquiring company or try to block the sale.

What Is a Merger in Healthcare?

During an acquisition, one organization absorbs the other. In contrast, the two organizations join forces during a merger. A payer merger might involve two similarly sized insurance companies teaming up to create a new, separate, larger organization. A payer might combine with a services provider to create a more robust product offering. Usually, mergers occur between two similarly sized organizations.

After a merger, the two organizations become the same legal entity. For example, if two healthcare payers merge, the new organization might change its name to reflect the shared market or to unify the formerly separate names.

Genuine mergers are less common than acquisitions because it’s less likely that both organizations will benefit equally from combining their resources.

Here are some of the reasons to consider a merger.

  • Reduce costs: When two healthcare payers become one, they share expenses, which can help save money. For example, the two payers might move into the same office space, significantly reducing the cost of rent. Some employees could become redundant, lowering the cost of labor.
  • Increase market share: Merging two healthcare payers allows them to increase their market share. The two insurance companies share members after the merger.
  • Improve patient care: The less work there is for the patient, the better their quality of care. When a healthcare payer merges with a company that provides services such as telehealth, getting access to care becomes much more straightforward. Patients can also feel more confident that their insurance will cover the cost of services they receive from all companies connected to the payer.

What Are the Benefits of Mergers and Acquisitions?

If growth is one of your healthcare organization’s goals, a merger or acquisition can help you achieve it. In addition to expanding your organization’s reach and market share, here are some of the benefits of a merger or acquisition.

If growth is one of your healthcare organization's goals, a M&A can help you.
  • Creates a more patient-centric organization: Whether you acquire another payer or join forces with an organization, you can build a patient-focused organization. Expanding the size of your administrative staff by merging with another payer or a healthcare services provider can improve claims processing and increase efficient, accurate billing. An acquisition or merger can also increase the size of your member support teams, such as call center representatives. You can also offer direct services to patients, such as through telehealth nurses and physician’s assistants, creating more care opportunities..
  • Raises employee engagement: Smaller payers often expect employees to take on extra tasks, potentially leading to burnout. When more people share duties and the efforts of two organizations have combined, the workload lightens. That can lead to more engaged employees who are excited to come to work daily.
  • Creates more opportunities for your organization: Acquiring another healthcare payer or organization lets you move into regions you wouldn’t otherwise have access to or add services your organization didn’t previously offer. The more geographically diverse or well-rounded your organization is, the further its reach and the more potential it has to establish itself as a leader in the industry.

How to Negotiate a Merger or Acquisition in Healthcare

During a merger or friendly acquisition, you want an outcome that works for both parties. The secret to a successful merger or acquisition is having a specific idea of what you want to gain from it before beginning the process. Knowing what your organization needs to grow will guide you through the process of choosing another healthcare company to merge with or another practice to acquire. Don’t rush the process.

It can be helpful to get outside support during the M&A process. ProspHire’s growth and expansion services can help you develop a strategy to improve your organization’s profits and to secure its future.

Acquiring another healthcare organization lets you move into regions you wouldn't otherwise have access to

ProspHire Can Help Your Healthcare Organization Grow Through M&A

If you’re ready to transform your healthcare organization, ProspHire is here to help. Our business growth and expansion division has experience providing support to organizations that want to grow internally and externally. We work with you to develop a strategy and roadmap to guide you to where you want to be. Contact us below to learn more.

ProspHire Continues to Expand with Philadelphia Office Opening

PITTSBURGH, PA – ProspHire, a national management consulting firm focused on healthcare advisory, project delivery and strategic resourcing, announced today an expansion of its presence through the addition of 3,500 square feet of office space in the Philadelphia market to accommodate the Firm’s fast-growing client-base.

The expansion will help to better serve local health insurance and provider systems in the market. ProspHire’s expertise in managed care programs (Medicaid, Medicare and DSNP markets) will be especially relevant to local health plans who are facing challenges with rapidly changing regulations and membership changes because of the “new normal” that is emerging from the COVID-19 pandemic.

Located in King of Prussia, this new, modern office space offers a wide array of meeting areas from enclosed glass rooms with large flat-screen TVs, community seating areas and a town hall area to host larger team gatherings. Additional features include a fully stocked kitchen, TVs integrated with cutting-edge screen sharing and communications systems and community seating for up to 50. Our clients will also be able to leverage these spaces for in-person collaboration while partnering with ProspHire on their engagements.

ProspHire has had tremendous growth since its founding in 2015. “We’re opening the office in Philadelphia at such a vibrant time, hoping to take advantage of the city’s energy and making it easier for healthcare consulting talent to take the next step in their career with us,” said Lauren Miladinovich, Managing Principal and CEO. “We believe King of Prussia is the perfect location for our clients and our employees alike. We’re excited to experience all the area has to offer and expand our business to Philadelphia and the surrounding market.”

Since ProspHire’s inception, the Firm has provided clients with unmatched quality and service and helped a variety of healthcare organizations implement transformational solutions that have allowed their businesses to thrive. The Leadership Team believes that a boutique healthcare consulting firm can truly make a bigger difference in Pittsburgh, Philadelphia and across the United States for healthcare organizations that need innovative, value-add solutions. Being in the Philadelphia market also enables ProspHire to hire motivated practitioners who know and understand local clients. The hope is to inspire them in building closer connections and providing innovative solutions for complex health plan challenges.

ProspHire continues to receive workplace accolades for its culture. In 2022, Modern Healthcare named ProspHire a Best Places to Work in Healthcare for the third year in a row. In 2021, the Firm also ranked in the top ten on the Pittsburgh Business Times Fast 50 List of the Fastest Growing Private Companies in the Pittsburgh Region. Additionally, ProspHire was named an unprecedented 2 years in a row to 2021 Inc. Magazine’s annual list of America’s Fastest-Growing Private Companies – the Inc. 5000.

About ProspHire
ProspHire is a national management consulting firm focused on healthcare advisory, project delivery and strategic resourcing. Founded on the core value of relationships, with the goal to “prosper together,” ProspHire partners with clients to identify and solve their most significant people, process and technology challenges. The woman-owned and rapidly growing Pittsburgh-based firm has nearly 100 practitioners and consultants who deliver exceptional service to each one of our clients across the U.S. Visit

Prior Authorizations in Medicare Advantage: New Concerns and How to Address Them 

OIG Study
The Office of Inspector General (OIG) recently published a report on a study completed showing significant issues in prior authorizations for Medicare Advantage members. The investigation was sparked by a concern that Medicare Advantage organizations were denying or delaying coverage for procedures and services allowed by the Centers for Medicare and Medicaid Services in both Medicare Advantage Plans and covered under traditional Medicare benefits. In a randomly selected sample, the OIG determined that prior authorization determinations in some cases were not consistent with Medicare coverage rules and Medicare Advantage billing rules. The findings in this study were consistent with previous studies published in 2018. 

OIG Findings
In this study, 13% of the denied services met Medicare coverage rules. The study provided examples related to decisions for the payor incorrectly time limiting a follow-up MRI scan.  Another example was denying a post-polio patient a walker that had previously used a cane.  One of the issues identified in the study was the fact that Medicare Advantage Organizations were applying clinical criteria that Medicare does not require.

In the second part of the study, the OIG investigated payment denials resulting in an 18% error rate based on Medicare Advantage billing rules. One of the reasons cited in the study for the issues was human errors during the manual review process. Examples included denial of a claim for a non-par provider in an in-network facility and a reviewer missing a prior authorization that led to claim denial for radiation treatment. Other errors were related to programming issues in claims processing systems, such as incorrectly identifying tax identification numbers or incorrect time-frame identification for coverage. Another was related to a more restrictive policy requiring an x-ray before an MRI or a MRI before therapy. Other treatments were inconsistent with Medicare National Coverage Decisions governing the plan.

The list of issues identified in the study is extensive. The OIG provided CMS with recommendations that will require Medicare Advantage Organizations to consider the similar problems they may have in their prior authorization processes and procedures. CMS agreed with the OIG recommendation to issue new guidance on clinical criteria, update audit protocols and direct Medicare Advantage Organizations to take additional steps to identify and remedy issues in manual and system errors.

How ProspHire Can Help
At ProspHire, our team of utilization management experts can rapidly assess your current policies, procedures and processes for prior authorization issues and provide a detailed playbook for addressing problems identified in the assessment.  We will help you navigate the issues and mitigate potential audit risks represented by the OIG report. Working with your team, we can support the implementation of the playbook, including updating policies, training staff and executing transformation to processes and systems to remedy potential errors. We will review current prior authorization criteria and improve the accuracy and the workflow issues that may be causing problems. We believe proactive evaluation and execution can limit the risks to the organization while enhancing processes that may be causing issues for the organization. 

To read the full OIG Report:

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