HMO Affiliates, LLC, (Affiliates) is a special projects healthcare consulting firm intensively focused on Managed Care Organizations. Founded in 1996, Affiliates specializes in Executive Management of HMOs, including Operational and Financial Management and also provides a full range of Merger and Acquisition Services, including Due Diligence. We also provide Litigation Support Services and assistance with all Regulatory Reporting and Compliance matters.
Our experienced healthcare professionals are especially well prepared to address difficult challenges and have done this successfully for many years. We have ourselves, been owners, directors, and officers of numerous healthcare companies and use the insights gained from this experience to quickly grasp the operational complexities posed by your specific issues, which in turn allows us to provide a clear vision for defining and accomplishing goals and objectives.
Ours is a “hands on” approach to Management Consulting. While we always remain as unobtrusive as possible to your organization’s day-to-day operations, we realize that your business objectives, needs and challenges, often require us to work with a sense of urgency as agents of change. As important as any other function we perform is the role we play in establishing effective communications within your organization, from the board level to your executives and department managers, as well as with government regulators and other outside entities that interact with your business.
We invite you to examine our credentials and some specific examples of completed engagements. We would be pleased to answer your questions and discuss how our services can benefit your organization. Be assured that we always adhere to strict confidentiality requirements and are personally committed to maintaining the highest professional standards and ethical conduct in all client matters.
In a recent assignment that typifies our skill sets, we developed and directed a major industry consolidation effort in Florida for an HMO client that was experiencing several years of significant financial losses in a -0- growth area of the state. After intensive evaluation we recommended that the client pursue an aggressive expansion into a higher growth market.
We were retained to execute a “roll up” strategy with strict time line requirements. Our group prepared the target analysis, capital financing plans, and successfully negotiated the acquisition of 5 separate HMOs in approximately 12 months. The HMOs had a combined membership totaling 500,000 covered lives with initial consolidated revenues of $1.2 billion.
Our efforts included negotiating and pricing the acquisitions, performing all due diligence, and completing regulatory filings and public hearing testimony. The engagement involved the conversion of 2 non-profit entities to for profit status and leading the integration and consolidation for all 5 companies which now form the 4th largest HMO in the state of Florida, with nearly ¼ of the lucrative South Florida market share.
We also performed the CEO and CFO functions for some of the companies during the transitions. These combined entities were recently acquired by a major publicly traded company in a highly successful cash transaction for our client. (We have been granted permission to furnish specific references on request.)
More about what we do:
Mergers, Acquisitions and Due Diligence: We are Transaction Specialists with extensive experience and contacts within the Managed Care industry. We can help you identify appropriate acquisition targets and provide important assistance in closing the deal. We have the hands on experience to complete the detailed work required for successful diligence and know the questions to ask and where to look to discover and verify answers. We understand the business implications of information gained through due diligence and the need to facilitate the flow of communications between buyers and sellers and other appropriate parties involved in the transaction. Specifically some of the tasks include:
Due diligence reviews,
Capital financing plans,
Regulatory filings and testimony before Government Regulatory Agencies.
We maintain a current network of contacts with HMOs and State Insurance Regulators across the US and quickly become aware of many new developments and situations as they occur. Our history of integrity in solving difficult regulatory and financial compliance issues with government agencies in numerous states allows us excellent access and professional credibility with these regulators. Working frequently as we do, with physician groups, hospital organizations, and governmental healthcare agencies, provides us with important information and personal contacts that we find valuable for managed care planning and development, as well as operations.
Many of the successful managed care entities we work with are interested in acquisitions, expanding into new states or establishing new lines of business such as new Government Programs. We help increase the effectiveness of these development efforts.
Our highly qualified and experienced Strategic Planning and Development Executives are available to meet with Board Committees and Senior Management of Health Plans to help evaluate your planning and development strategies. Call us for a free consultation
We also provide turn-key HMO “Startup” services including:
Certificate of Authority,
Executive Management and Administrative Staff Building,
Provider Network Contracting, and
Medicare and Medicaid Contracting.
Senior Management of Health Plans
Having completed major assignments in numerous states, we have evaluated the operations of HMOs, prepared documented historical analysis and provided current assessments. We have also developed and implemented financial and operational turnaround strategies and prepared formal Corrective Action Plans. Occasionally, HMOs may require temporary operational and/or financial management services or assistance in finding qualified permanent executive management and officers. We can provide highly experienced and exceptionally well qualified Senior Management personnel on short notice; including Chief Executive Officers, Chief Operating Officers and, Chief Financial Officers. We have managed HMOs in numerous states and maintain contact with a current network of working HMO executives and managers from which to recruit the best individuals available. We have managed HMOs in Administrative Supervision and have worked closely with State Regulators to Rehabilitate Financially Impaired entities. If your organization is experiencing operational or regulatory difficulties and you need an effective management solution, contact us for a free consultation. Complete Confidentiality is assured.
We are well qualified, with short notice to assume full management responsibility for the operations and/or the financial management of your Managed Care Organization. In less critical circumstances, we can assist your senior management team by narrowly focusing on the special projects required to address your specific challenges assist in forming business strategies. We can offer “Thought Leading Discussions” for Maximizing Revenues and Introducing Cost Efficiencies and we have an extensive track record in solving complex operational problems. Our Managing Directors each have over 20 years senior management experience directing Publicly Traded Managed Care Companies, National CPA Firms, and Healthcare Consulting firms.
In a recent assignment for an HMO client we provided Litigation Support and Trial Testimony as Healthcare Industry Experts. In an unusually complicated civil litigation proceeding against a considerably larger and well funded HMO operator we provided an independent factual investigation and forensic accounting services. We also consulted with legal counsel and provided key testimony at trial which resulted in a jury verdict for our client. The case was subsequently settled and involved a substantial recovery for our client.