Strategic Planning Financial Modeling Summer 2019

We have a baseline financial forecast that we would like to have a financial modeling specialist use to develop scenarios around possible strategic and tactical business modifications. We are a health plan and would benefit from a party with specific expertise in the financial modeling for health care payors across commercial and government sectors.

Each of these will entail some adjustment to the variables such as:

i) risk score which drives revenue
ii) STAR score which drives revenue
iii) Admits (inpatient) per thousand members which drives medical costs and MLR
iv) Clinical such as MD, PCP, RN, Pysch and NP (Nurse Practitioner} Ratios which affects our internal costs/administration - and could simultaneously affect the above variables
v) Patients per provider such as PCP or NP - so the amount of leverage and coverage we get from an NP - as per above
vi) bonus payments to facilities for performance such as hospitals or SNFs (skilled nursing facilities), PCPs (primary care providers) and NPs - with linkages to performance so that higher performance drives better bonus payments
vi) IT investments which open up new markets and facilitate lower density of coverage likely from lower staffing NP ratios - with possible implications to the above metrics (Admit/RAF etc)

vii) additional services such as psychiatric which can impact the above metrics such as Admit/RAF