Healthcare Compliance

Reducing Program Risk and Stakeholder Burden

LMI has supported federal healthcare initiatives for over 20 years, furnishing analytic tools, policy expertise, and operational knowledge to enhance program oversight and model compliance activities. Through prospective and retrospective analysis, LMI helps the Centers for Medicare & Medicaid Services (CMS) and other federal customers monitor and manage significant programs, uncover risks, and determine mitigation strategies that lessen the burden for stakeholders. These strategies support the implementation of models of care that deliver quality, cost-effective health outcomes and ultimately foster a more efficient healthcare system.

Our Approach

LMI’s compliance approach centers on reducing programmatic risks while minimizing participants’ burden through data analytics and proactive engagement and education. Our proprietary analytic methods detect risks early in the model lifecycle so that mitigation strategies can be issued quickly, curtailing wasteful spending months sooner than expected. By promoting understanding through clear, concise recommendations, LMI helps participants contribute to model success and avoid burdensome remediation efforts for noncompliance. Our approach integrates technical and subject matter expertise to deliver mission-enhancing services and capabilities.

Monitoring and Oversight

Monitoring & Oversight

  Health Analytics

Health Analytics

  Health Analytics

Health Policy Expertise

  Program implementation

Program Implementation

  Tools

Customized Tools

Leveraging data engineering, analytics, and health policy expertise, we detect instances or patterns of fraud, waste, and abuse. Our policy experts outline compliance recommendations and engage stakeholders to ensure program integrity.

 

From trend analysis and anomaly detection to classification, clustering, and predictive analytics, we examine healthcare data with complex aggregation to furnish deliverables that support evidence-based planning and scenario-based analyses.

 

Experts in public health, public policy, operations research, and business management collaborate to define compliance parameters and identify needed data sets based on seminal documentation.

 

We design and implement concepts of operations that enhance stakeholder transparency, satisfying and recording all statutory and regulatory requirements.

 

From compliance monitoring to process automation, our tools operationalize insights to enhance communication, analytic, and oversight activities.

Meaningful Results

LMI has supported CMS offices and programs for over 20 years, furnishing project and program management, compliance planning and oversight, and stakeholder engagement and education.

Advancing Model Development at the Centers for Medicare and Medicaid Innovation (CMMI)

LMI has supported compliance oversight for six CMMI models:

  • Comprehensive Primary Care Plus (CPC+),
  • Comprehensive End-Stage Renal Disease Care (CEC),
  • Accountable Care Organization Investment Model (AIM),
  • Pioneer ACO, Next Generation ACO,
  • and Advance Payment.

Among its program integrity responsibilities, LMI audits the CPC+ model, which consists of nearly 3,000 primary care practices in 18 regions, and performs scheduled and ad hoc auditing for CEC and Next Generation ACO model participants.

Enabling Program Efficiency for Medicare Advantage (MA)

LMI analyzed and monitored compliance of over 5,000 care plans for the MA program, which covers more than 20 million beneficiaries. LMI built an integrated suite of in-house systems and customized tools to perform qualitative and quantitative analyses of each plan. LMI’s approach has accelerated processing of repetitive requests, enabling customers to spend more time and resources on time-sensitive and emerging benefit policy issues. With over two decades of experience in supporting MA across seven divisions, LMI’s analyses inform updates on the health of the program to external stakeholders and afford insight into program improvements.

 

Supporting Accountability and Transparency throughout CMS

LMI’s health policy experts have drafted and cleared sections of proposed and final rules, prepared reports to Congress, and presented detailed accounts of model performance and program findings to external stakeholders on behalf of several CMS customers, including CMMI, the Center for Consumer Information and Insurance Oversight, Medicare Advantage, and the Medicare Shared Savings Program.

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