Author: LBodnarchuk

Chris Miladinovich with blurred background

ProspHire Co-Founder and Principal Named New Chief Strategy Officer

PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, is pleased to announce Co-founder and Principal, Chris Miladinovich, has been named the Firm’s first Chief Strategy Officer. In this new role, he is responsible for overseeing business development, client relationships, strategic partnerships and the Firm’s long-term strategic plan. Prior to this, Chris was ProspHire’s Chief Operating Officer in charge of the operational business units, including Finance, IT and Administrative Operations.

“I am ecstatic for the opportunity to take on this new role. ProspHire has an incredible culture that has led to tremendous growth all with an eye on improving the client experience,” said Chris Miladinovich. “My passion has and always will be to help our people and our clients succeed. Today our clients are searching for innovative solutions for their complex healthcare problems and we are focused on helping them improve their organizations in order to help their healthcare members.”

Chris brings over 20 years of experience leading large-scale, complex business transformation programs from a billion dollar, Big 4, consulting organization to an emerging business. His leadership has been focused on developing and delivering technology-driven business services and solutions in the healthcare industry and he has been responsible for managing over $20 million in annual revenue, providing outstanding client experiences and driving profitable growth.

“We are excited to have Chris take on this new role as he brings an invaluable blend of industry experience and execution,” said Lauren Miladinovich, ProspHire’s Co-founder, Managing Principal and Chief Executive Officer. “With his extensive knowledge, industry partnerships and strategic vision, Chris has stood by my side leading and growing ProspHire since 2015. We look forward to achieving that same level of success as he executes on ProspHire’s long-term strategy in the years ahead.”

Chris and Lauren have recently been named Entrepreneur of the Year® 2023 East Central Finalists.

benefits optimization in healthcare

Benefits Optimization in Healthcare: Application and Timeline

Healthcare organizations today are under pressure to deliver quality care while managing costs. Benefits optimization in healthcare is one strategy that can help achieve these goals. By evaluating and optimizing product benefits, organizations can provide their members with favorable core and supplemental benefits based on market trends while also managing costs.

One of the key drivers of increased enrollment for healthcare organizations is the benefits optimization cycle. The application of benefits optimization in healthcare can lead to significant increases in enrollment, improvements in operational efficiency and financial improvements over time.

In this blog post, we’ll explore the concept of benefits optimization in healthcare, including its definition, examples of its applications and the timeline for its implementation. Understanding the benefits optimization cycle can help you make informed decisions about your product benefits.

What Is Benefits Optimization in Healthcare?

Benefits optimization refers to the process of maximizing the value of plan benefits an organization offers to their members. It aims to strike the balance between offering competitive benefits while keeping costs manageable.

Through data analysis, healthcare companies can identify areas where they can reduce costs while still providing valuable benefits by examining an organization’s enrollment and benefit utilization data. For example, an organization can identify trends based on what plans are receiving greater enrollment or which benefits are the most utilized by plan. Additionally, healthcare consulting firms can help organizations assess and optimize their product benefits to ensure they align with their short and long-term business goals.

Overall, benefits optimization in healthcare is all about finding the right balance between member need, member satisfaction, and cost control. By leveraging data analysis and expert guidance from healthcare consulting firms, organizations can ensure they’re providing competitive benefits while keeping costs manageable.

Examples of Benefits Optimization Applications

Examples of how healthcare providers can apply benefits optimization

Benefits optimization is a vital aspect of healthcare management that can help organizations maximize the value of their product benefits while reducing costs. Here are a few examples of how healthcare providers can apply benefits optimization:

1. Cost Analysis and Benchmarking

Organizations can use cost analysis and benchmarking techniques to identify areas of high healthcare spending and compare their product benefits to industry standards. This helps them understand where their healthcare dollars are being spent and identify opportunities to reduce costs while still providing high-quality benefits to members.

2. Plan Design and Strategy

Benefits optimization also applies to plan design and strategy. By analyzing healthcare data and member utilization patterns, organizations can tailor their benefits programs to meet the specific needs of their enrollees. This can include offering more flexible benefits options, such as telemedicine or wellness programs, to encourage healthier lifestyles and reduce healthcare costs.

3. Vendor Management

Optimizing vendor management is another way to reduce healthcare costs while still providing high-quality benefits. By negotiating better contracts with vendors, organizations can save money on healthcare expenses and offer more comprehensive benefits to their members.

4. Compliance and Reporting

Compliance and reporting are critical components of benefits optimization in healthcare. Organizations must comply with state and federal regulations and report accurate data to regulatory agencies. Benefits optimization consultants can help organizations navigate these requirements and ensure they comply with all applicable regulations.

Overall, benefits optimization can provide significant benefits to healthcare organizations. By analyzing data, tailoring benefits programs to member needs and negotiating better vendor contracts, organizations can save money while still offering high-quality benefits to their members.

What is the Benefits Optimization Cycle?

The healthcare benefits optimization cycle is a systematic approach to improving healthcare benefits programs, encompassing various stages from assessment to measurement. By following this cycle, healthcare organizations can effectively analyze, strategize and optimize their benefits offerings.

Let’s explore each stage of the benefits optimization cycle and understand how it aligns with the Centers for Medicare and Medicaid Services (CMS) deadlines.

Assessment

The first step in the cycle is conducting a comprehensive assessment of current and emerging market benefits. This involves analyzing data on healthcare costs, member utilization patterns and satisfaction levels. Leveraging publically available data, one can quickly and efficiently have a strong grasp of the current marketplace. By understanding the existing program’s strengths and weaknesses, organizations can identify areas for improvement.

Strategic Planning

Based on the assessment, organizations develop a strategic plan to design new plan benefits or modify existing ones. This includes setting clear goals, defining strategies to achieve those goals and outlining the necessary steps for implementation.

Also, organizations might develop new products, expand their provider network or implement new healthcare technologies. Strategic planning also involves considering CMS deadlines, such as the Initial Enrollment Period, Annual Enrollment Period, Open Enrollment Period and Special Enrollment Period.

Implementation

In the implementation stage, healthcare organizations roll out their new or modified benefits programs to members. This step may include communicating with members to explain changes to their benefits packages, training healthcare providers on new processes or technologies or implementing new member engagement programs. Timely execution is crucial to meet CMS deadlines and ensure a seamless transition for members.

Measurement

The final stage of the benefits optimization cycle is measuring the outcomes and effectiveness of the implemented strategies. Organizations track key metrics such as cost savings, member satisfaction and healthcare utilization to assess the success of the optimized benefits program. This data-driven evaluation enables continuous improvement and helps organizations refine their strategies for future optimization cycles.

By following this cycle, healthcare organizations can optimize their benefits programs to increase enrollment, operational efficiency and financial performance.

The Benefits Optimization Cycle Timeline

The benefits optimization cycle timeline can vary depending on the healthcare organization and the specific benefits program the organization is optimizing. However, most benefits optimization cycles follow some general timelines: 

  • Assessment: The assessment stage of the cycle typically takes place at the beginning of the year and typically takes one to two months to complete.
  • Strategic planning: The design stage typically follows the assessment stage and may take anywhere from two to four months to complete. 
  • Implementation: The implementation stage typically takes place in the latter half of the year and generally takes one to three months to complete. 
  • Measurement: The measurement stage typically takes place at the end of the year and can take one to two months to complete. 

Here’s an example of the CMS application and bid submission timeline to understand how it aligns with the benefits optimization cycle:

  • November to February (Q4 to Q1): During this period, organizations submit a notice of intent to apply and complete the CMS application by mid-February.
  • March (Q1): The bid kickoff takes place, initiating the bidding process.
  • End of March (Q1): The first draft of benefits is completed, outlining the proposed benefits, coverage options, and associated costs.
  • April (Q2): Value-Based Insurance Design applications and the second draft of benefits are due.
  • Before May (Q2): The third draft of benefits is finalized.
  • May (Q2): The final proposed benefit review and assumptions finalization takes place.
  • June (Q2): The bid submission deadline arrives, and organizations submit their finalized bid packages to the CMS.

By aligning the benefits optimization cycle with the CMS application and bid submission timeline, healthcare organizations can ensure a comprehensive and compliant approach to optimizing their benefits programs in order to achieve strategic institutional goals.

Remember, the specific timeline may vary based on organizational needs, CMS requirements and other factors. However, following a structured timeline is key to achieving successful benefit optimizations in healthcare. 

Maximize Your Healthcare Benefits With ProspHire

Maximize your healthcare benefits with ProspHire

Benefits optimization in healthcare can help organizations maximize their benefits, reduce costs and increase member satisfaction. By following the benefits optimization cycle, organizations can continuously evaluate their product benefits, identify opportunities for improvement and implement changes to achieve their desired outcomes.

ProspHire offers expert benefits optimization services to help organizations navigate the complexities of healthcare benefits and achieve their goals. If you’re interested in learning more about how ProspHire can help your organization optimize its benefits, fill out our contact form today.

Rethinking Behavioral Health and SDOH

May is Mental Health Awareness Month – a reminder to all of us that checking in on your mental health is just as important as your physical health. Nationwide mental health trends reveal an increasing concern. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that one in five adults in the United States have a mental health or substance abuse disorder1. Nationwide trends in rates of mental illness reveal a rapid increase of instance over the past decade, as illustrated in Figure 1.

Graph Displaying Percent of People with Mental Health Illnesses in the Past Year

The American Medical Association defines behavioral health as encompassing the following conditions: mental health disorders, substance use disorders, life stressors and crises and stress-related physical symptoms2. For health plans and patients alike, often the first solution that comes to mind when addressing behavioral health issues is to focus on psychiatric interventions. Despite this assumption, mental and physical health are often intrinsically related and influenced by similar environmental factors. As a result, programs that utilize comprehensive Social Determinants of Health (SDOH) data to address behavioral health are often overlooked.

Behavioral Health and Social Determinants of Health

Social determinants, or drivers, are a useful indicator to identify factors which contribute to poor mental health in communities and individuals. Addressing health equity in all forms, including behavioral health, and SDOH factors are intrinsically related. Poor mental health can cause poor SDOH outcomes or vice versa. The National Library of Medicine3 notes that these outcomes are largely tied to food scarcity, inadequate housing, lower socioeconomic status and trauma among additional factors.

Social Determinants of Health that Cause Poor Mental Health

Expanding access to quality behavioral health services is a necessary component of efforts to address behavioral health and SDOH outcomes. The following indicators are associated with limited access to behavioral health services and present an opportunity for intervention:

  • Health Care, including insurance coverage and provider availability
  • Stable Housing – a significant contributor to mental stress
  • Education, especially from an early age
  • Income and Employment
  • Social Support

Clinical systems are still assessing ways to measure SDOH factors to inform behavioral health policies as there are still shortfalls in assessing these metrics4. Ideally, health plans, providers and communities can partner to address these issues.

Approaches to Target Behavioral Health through SDOH

Understanding and targeting the causal factors of mental health related to SDOH is critical in enabling mental health equity. The importance of various social determinants and their continuous evidence of impact on mental health is a call to action for improved whole-person care. Housing and food access highlight the whole-person impact of SDOH on health:

Stable Housing

Inadequate and unaffordable housing can result in poor mental health5. Increased access to affordable housing and adequate living conditions present examples of interventions focused on SDOH that would directly impact mental health. Poor living conditions such as mold, lack of heating and dampness can impact both mental and physical health. Overall, a lack of affordable housing within a community causes increased rates of homelessness which can lead to even greater mental health issues and physical health risks. An intervention to offer housing programs to those with mental health illness or housing vouchers to access affordable housing are examples of efforts to drive change.

Food Security and Healthy Diet

Access to food and a healthy diet are intrinsically tied to physical health and wellness; however, evidence suggests that unhealthy eating is also a contributor to poor mental health. Having a whole-person approach to care presents a potential intervention. Individuals with illnesses such as diabetes are more likely to have depression, highlighting the correlations between mental and physical health6. Increasing food security by delivering healthy food to farmers markets, community gardens, corner stores or through home delivery offers alternative opportunities for individuals struggling with poor nutrition due to lack of access.

Evidence of successful programs continues to arise as health plans, providers and communities’ partner to address social determinants of health. Pyx Health’s Loneliness Assessment is an example of a successful intervention.

Pyx Health Loneliness Assessment

Providers can also look to interventions which work in conjunction with health plans to address behavioral health and SDOH outcomes. Pyx Health, based in Arizona, is a healthcare company which works with Medicaid and Medicare plans to support individuals experiencing loneliness. Their process involves identifying vulnerable members through SDOH screening tools and offering vulnerable members 24/7 support7. Members use the app to express their needs and are subsequently connected with resources within their health plan and community. The approach improves behavioral health outcomes and reduces stress on clinical health resources. Given the limited amount of multi-dimensional approaches which specifically address behavioral health utilizing social determinants of health, this approach serves as inspiration for similar interventions.

How ProspHire Can Help

Through ProspHire’s Addressing Health Disparities service offering, we strive to support our neighbors and clients to achieve more equitable whole-person care. Through population health assessments, targeted Social Determinant of Health interventions and innovative solutions to support behavioral health needs, we hope to enable positive change for your customers and our communities.


1 https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases

2 https://www.ama-assn.org/delivering-care/public-health/what-behavioral-health

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863696/

4 https://www.healthaffairs.org/do/10.1377/forefront.20210610.928520

5 The impact of persistent poor housing conditions on mental health: A longitudinal population-based study – PubMed (nih.gov)

6  Diabetes and Mental Health | CDC

7 https://www.pyxhealth.com/

ProspHire Recognized as one of the Best Places to Work in Healthcare Four Years in a Row

PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, has been selected by Modern Healthcare as one of the 2023 Best Places to Work in Healthcare. The award program identifies and recognizes outstanding employers in the healthcare industry nationwide. Modern Healthcare partners with Workforce Research Group on the assessment process, which includes an extensive employee survey.

“Thank you to all of our dedicated employees who recognize ProspHire as an outstanding employer in the healthcare industry,” said Lauren Miladinovich, Co-founder, Managing Principal and CEO. “Be it an uncertain economy, staffing shortages or increasing demands of flexibility and remote work opportunities, our leadership team constantly strives to understand what our employees need and want in today’s business environment.”

“We are incredibly proud of our fourth consecutive win of the healthcare industry’s most prestigious award. This remarkable achievement is a testament to the unwavering dedication of our team, whose collective spirit and commitment to excellence have made ProspHire a Best Place to Work. We are grateful for this recognition and will continue to foster a thriving, inclusive and empowering environment for our people to innovate, grow and make a meaningful impact in healthcare,” said Chris Miladinovich, Co-founder, Principal and COO. “Next year is one for the thumb.”

ProspHire will find out the ranking on the Best Places list on September 28.

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 www.prosphire.com.

ProspHire Ranks Among the Highest Scoring Businesses on INC. Magazine’s Annual List of Best Workplaces for 2023

PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, has been named to Inc. magazine’s annual Best Workplaces List for 2023. The list is the result of a comprehensive measurement of U.S. companies that have excelled in creating exceptional workplaces and company culture, either operating in a physical or virtual facility.

Inc. selected 591 honorees this year. Each company participated in an employee survey, conducted by Quantum Workplace, which included topics such as management effectiveness, fostering employee growth and overall company culture. Organization benefits were also audited to determine overall score and ranking.

“Being named to Inc. Magazine’s Best Workplaces is an honor,” said Lauren Miladinovich, Co-founder, Managing Principal and CEO. “Proving to the world that you are a magnet for talent and have a culture that keeps teams engaged, productive and proud to come to work is truly a remarkable achievement.”

The List of Best Workplaces will be featured in the May/June 2023 issue of Inc. Magazine and prominently featured on inc.com.

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 www.prosphire.com.

Women’s Health Week

Did you know? May 14-20 is Women’s Health Week!

Women’s Health Week is aimed to raise awareness about the manageable steps women can take to improve their health and lifestyle. Incorporating simple preventative and positive health behaviors into their everyday lives is important. One’s lifestyle organically impacts day-to-day behaviors that can lead to downstream impacts both positively and negatively. Women’s Health Week provides an avenue for others to share their experiences and enhance exposure to learning opportunities that may have not been realized. During this time of the year, women are encouraged to maintain their preventive screenings, healthy life choices and rejuvenate. ProspHire encourages women to consider the factors that influence their mental health, such as managing stress and talking about anxiety and depression. 

CDC recommendations to improve physical and mental health

To improve physical and mental health, the CDC recommends that women:

  • Get regular checkups, including a yearly well-woman exam. Talk to a healthcare provider about any health concerns you have.
  • Get active.
  • Eat a healthy and balanced diet.
  • Prioritize your mental health and learn how to cope with stress.
  • Practice healthy behaviors. Daily decisions influence your overall health.

Why is Women’s Health Week important?

Women’s health plays an important role within the Healthcare industry that is driven by quality. It brings added awareness and accountability by way of preventative based HEDIS measures which are monitored by providers, health systems, health plans and members themselves. HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA), which allows direct, objective comparison of quality across a multitude of value-based care programs designed to improve the quality of care to members regardless of age, gender, finance and other social determinants.

HEDIS measures dedicated to women's health with a focus on prevention

There are specific measures within HEDIS dedicated to women’s health that focus on prevention:

Breast Cancer Screening (BCS) Women who had one or more mammograms to screen for breast cancer during the measurement year or the two years prior.

Cervical Cancer Screening (CCS) Women who were screened for cervical cancer within the eligible time frame.

Chlamydia Screening (CHL) Women who were identified as sexually active and who had at least one chlamydia test in the measurement year.

Prenatal and Postpartum Care (PPC) The percentage of deliveries that received a prenatal care visit and or postpartum visits within the eligible timeframe.

Within HEDIS performance it is expected that better outcomes lead to more enrollees, visits and overall engagement compared to competitors. Physician-specific scores are being used as evidence of preventive care from primary care office practices. These measures are also the basis for physician incentive programs such as ‘pay for performance’ and ‘quality bonus funds’.

How can ProspHire Help

How Can ProspHire Help?

At ProspHire, we have dedicated subject matter experts with experience supporting health plans, provider groups and health systems to yield positive quality outcomes that trickle down to enhanced patient and member experience, improved quality of care and reduced costs. Connect with one of our health care experts today.

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