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Current company Cms1partners
Operations Consulting · 1 employees · Ny, New York, United States
At CMS1Partners.com Our team combines deep managed care expertise with real-world operational experience across Medicare Advantage, Medicaid, and value-based care—helping organizations improve quality, optimize risk, and manage cost through practical, compliant, and data-driven solutions. Care Strategy We partner with health plans, IPAs, MSOs, and provider groups to design and operationalize value-based care strategies that improve outcomes, control total cost of care, and align incentives across clinical, financial, and operational teams. Performance & Quality Optimization We conduct deep performance reviews across quality, risk adjustment, utilization, and financial metrics to identify gaps, prioritize opportunities, and implement actionable improvement plans tied to HEDIS, CMS Star Ratings, and contract performance. Risk Adjustment & Revenue Integrity We help organizations maximize appropriate risk capture through compliant risk adjustment strategies, documentation workflows, and audit readiness—ensuring accurate reimbursement while reducing regulatory and financial risk. Network & Provider Performance Management We support provider network optimization by assessing contract alignment, provider performance, care delivery variation, and engagement models—driving accountability, collaboration, and sustainable performance improvement. Utilization & Cost Management We advise on utilization management and care management transformation to reduce avoidable admissions, emergency department overuse, and high-cost leakage—while improving member experience and care coordination. Data, Analytics & Operational Enablement We translate complex data into actionable insights by aligning analytics, reporting, and operational workflows—enabling leadership to make informed decisions across quality, finance, compliance, and population health.