CHALLENGE

After taking on significant new membership, a managed care plan began experiencing critically high Medical Loss Ratio and the risk of serious operational losses.

WESTMONT SEARCH SOLUTION

We met with senior leadership and determined that significant organizational changes were necessary. After several stakeholder meetings, we recommended refocusing staff and adding new talent in the Medical Management and Finance areas. We identified and recruited new leaders who had successfully addressed similar issues at other organizations. The new leadership focused on medical case management programs, pharmacy solutions and a change in utilization management to reverse the trend.

OUTCOME

Our client anticipated that it would take up to a year to reverse the losses. However, the new leaders successfully managed the turnaround in less than six months.