Our Results
The team behind Refulgent Strategies has an extensive track record of achieving client goals, representing over $12.5 billion in premiums, more than 2.6 million patients, and over 4,000 independent health care services providers. Some of the most notable results they have produced include:
Devising the negotiation strategy and process of more than 20 contracts between healthcare providers and insurance companies, which resulted in more additional benefits for providers valued at $130 million.
Managing a value-based payment (VBP) pilot program in New York State that included 6 insurance companies, 120 medical practices, and 125,000 Medicaid beneficiaries, resulting in a $40 million surplus and improved quality of care for patients.
Leading an initiative for a New York-based provider group that regulated in the identification of $7.5 million in savings due to medicine prescriptions.
Developing an automated module and process standards for the management of privacy issues, resulting in the avoidance of fines, improvement of efficiency, reduction of investigation time and administrative cost, and savings of over $13 million.
Working with insurance companies to implement a process to detect and prevent fraud attempts, resulting in the protection of over $12 million in payments to date.
Intervening on behalf of healthcare providers to release over $21 million in payments to healthcare providers that had been stalled due to government processes.
Spearheading an insurance company’s compliance to new changes to the HIPAA law, revising and implementing new policies and procedures, inspecting affected contracts to follow legal requirements, to avoid over $2 million in fines by the Office of Civil Rights of the Department of Health and Human Services (HHS-OCR).
Implementing a process for the referral of employees who violated privacy policies and procedures as required by regulations. This avoided over $1 million in fines and strengthen privacy protection and information security.
Redesigning organizational structures and long-term strategic plans so health care providers could effectively manage the risk of up to 93% of premiums.
Designing a process for eligibility reconciliation with the monthly capacitation payment to IPAs that captured more than $400,000 en errors by New York insurance companies.
Carrying out an intervention program based on social determinants of health, through which thousands of beneficiaries received social support through alliances with community organizations focused on combating economic inequality, housing insecurity, and food insecurity.
Establishing a program as commissioned by the State of New York to provide primary medical services to thousands of minors separated from their parents at the US-Mexico border.
Directing the development of an innovative proposal to support the government of the Dominican Republic in its transformation of its hospital-based healthcare system to a primary care-based system.
Guiding a humanitarian mission to support those impacted by Hurricane María’s landfall and mitigate the storm’s burden on health systems. The mission impacted more than 30,000 patients through temporary medical clinics, delivery of prescription drugs, and the distribution of food.