Client Context
A national non-profit focused on improving the health and wellness of aging populations faced significant barriers in creating a sustainable financial model for its services. While the organization offered evidence-based wellness programs and tools to address social determinants of health (SDOH) such as food insecurity, social isolation, and transportation barriers, its reliance on grants and philanthropy posed challenges for long-term financial sustainability. The leadership sought expert guidance to align their mission with practical business solutions that could attract payer partnerships, demonstrate measurable ROI, and enhance operational capabilities.
Our Approach
To address the organization’s challenges and unlock its potential for payer engagement, Akros Advisory deployed a rigorous, data-driven methodology centered on delivering tangible outcomes. Grounded in deep industry expertise, our work spanned four critical areas:
Strategic Assessment of Opportunities We began by conducting an exhaustive analysis of the healthcare ecosystem, focusing on the intersection of the client’s offerings and payer priorities. Our insights uncovered key opportunities:
The organization’s existing programs aligned strongly with value-based care metrics, particularly in reducing social isolation and addressing transportation insecurity. These represent areas of high payer interest, given their impact on Star Ratings and cost containment.
Emerging trends, such as CMS’s planned Health Equity Index (HEI) measures, signaled a strategic opening to position the client as a leader in health equity partnerships.
Data-Driven Insights and Optimization Leveraging the client’s proprietary data, we quantified the outcomes of its existing programs, transforming anecdotal success into actionable evidence. Our analyses highlighted:
The 81% increased risk of falls among individuals experiencing food insecurity and the corresponding potential to demonstrate programmatic ROI.
A segmentation strategy targeting high-risk subpopulations that could yield a projected 265% ROI compared to a blanket approach.
We enhanced these insights with best-in-class benchmarks and payer-specific data, presenting a compelling case for reimbursement-ready services.
Reimagining the Business Model Recognizing the limitations of the grant-dependent framework, we designed a scalable, sustainable model anchored in reimbursement pathways:
Introduced a Management Services Organization (MSO) model to consolidate operations, billing, and analytics for the client’s CBO network, enabling cost efficiency and improved service delivery.
Identified and validated CMS-approved reimbursement mechanisms, including Special Supplemental Benefits for the Chronically Ill (SSBCI) and Medicaid waivers, to fund key programs.
Proposed monetization strategies for the client’s rich dataset, aligning with payer goals for improved member outcomes and risk stratification.
Actionable Implementation Plan To transition from strategy to execution, we provided a clear roadmap, prioritizing quick wins alongside long-term initiatives:
Developed targeted messaging and engagement strategies for Medicare Advantage (MA) and Medicaid Managed Care Organizations (MCOs), highlighting the client’s ability to directly improve metrics tied to Star Ratings and cost savings.
Delivered a blueprint for achieving NCQA Health Equity Accreditation, positioning the client as a preferred partner in advancing health equity.
Crafted a framework for scaling the model nationally, with strategic partnerships and phased market entry plans to ensure rapid and sustainable growth.
Client Feedback
“Akros Advisory brought a deep understanding of our mission and the healthcare ecosystem. They were insightful, flexible, and responsive as our needs evolved, always keeping the people we serve at the heart of their recommendations. Their ability to bridge our vision with practical business solutions was invaluable.” - VP of Business Development, Regional Non-Profit
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