Prospective Health

Health Plans

“Paul is one of those rare individuals who is a very effective listener and communicator making his skill as a trusted consultant and advisor even more valuable. I have the highest level of respect for his business intellect and value his counsel. While I have known Paul for over 10 years, and have worked with him on various industry-related projects, his recent engagement with us on product specific evaluations has helped us focus on needed strategic adjustments. I score Paul’s work as an A+.”
Mark White
President and CEO
Arkansas Blue Cross and Blue Shield

Strategic Planning Facilitation

Paul von Ebers is known in the health insurance industry as a thoughtful strategist who understands all aspects of the health insurance business. In addition to his senior management experience, Paul has also been a senior adviser to health insurance companies, hospitals and health care IT organizations. He is an excellent facilitator who will help a management group develop their own strategy. An industry expert, Paul can ask the right questions, probe and pull suggestions from executive leadership teams without imposing his own views on the process. Paul has a passion for helping executive teams find and develop sustainable sources of strategic advantage. Finding these sources of advantage is the difference between creating a good health plan and a great one.

Shared Services

Many small to medium sized health plans are confronting new market requirements, which are imposing large new burdens on them. Converting from an employer-oriented to a consumer-oriented health plan requires new retail market skills and capabilities. Risk management, consumer marketing and provider contracting all require extensive data analytic resources. Specialized markets such as Medicare Advantage, PDP and Medicaid managed care require specialized skills. The new regulatory requirements of the ACA and government programs require changes to operational requirements and much more extensive compliance activities.

This is a short list of the new skill and capability areas that are required in the new market. Many health plans realize it will be difficult to acquire and retain the talent, build the infrastructure and manage the vendors necessary for these capabilities. Faced with this dilemma, smaller health plans face a stark choice of merging with a larger partner or finding ways to share capabilities with other health plans.

Paul von Ebers has faced these concerns as the CEO of two small to medium sized health plans. He has experience in shared services enterprises and is familiar with the challenges and opportunities of such arrangements. Paul understands the tradeoffs between autonomy of each health plan and the need to leverage scale across multiple health plans. Paul can help smaller health plans think through their options, identify potential partners and facilitate sharing discussions to clarify objectives and goals among the parties.

Paul is currently assisting several health plans as they think through their options and strategy on shared services.

Accountable Care Relationships

Health plans are seeking to re-envision their relationship with the health care delivery system from a fee-for-service relationship to a value-based purchasing relationship. At the same time, consolidation is creating new, mega health systems that can have near monopoly bargaining power. The Affordable Care Act also includes incentives for health systems to go directly to market in competition with health plans. This environment creates tremendous challenges, but also great opportunity for health plans to refashion their role in the market.

Paul von Ebers has extensive experience in designing and negotiating all types of contractual relationships between health plans and health systems. Paul has been on the health plan side of these negotiations for one part of his career, and on the health system side for another portion. He has worked through risk sharing, global budgets and quality incentive based systems. He is a keen strategist on how to get to win-win relationships. Paul can help executive management teams clarify their objectives, create a plan for negotiation and implementation and create measurement systems for success.

Product, Segment and Line of Business Turnaround

Successful health plans sometimes have a product, line of business or segment that is not meeting objectives. Paul von Ebers has successfully turned around a Medicare Advantage plan, a Medicaid HMO, a Medicare Supplement product line, several commercial HMO products and a third party administrative organization. Paul can help your team think through an action plan to return a product, line of business or segment to growth and profitability. He will bring a supportive outsider perspective to ask questions that may not have been asked and offer suggestions on what has worked in other situations. Paul is currently working with a health plan to turn around a Medicare Advantage product line.

Temporary Executive Services

If your organization loses a key executive and you do not have an immediate replacement available, call on Prospective Health for temporary executive services. We have a network of contacts with current and retired executives with extensive experience in every area of health plan operations. We can place a temporary executive with you to maintain continuity of operations and assist in the recruiting process for a permanent executive.

Leave a Reply