Healthcare Performance • Redesigned. Aligned. Delivered.
We Don't Theorize ROI.
We've Delivered It.
HLTHWORKS has generated $16.65B+ in measurable impact across 30+ health plans, health systems and medical groups — across Risk Adjustment accuracy, Star quality, network performance, cost of care, and AI & Digital Health transformation. Not in aggregate, Per engagement.
$16.65B+
Total Delivered Impact - 30+ Engagements
$555M
Impact in a single health plan engagement
$245M
Risk Adjustment accuracy - One Client
100+
Health Plans, Systems & Medical Groups Served
Where Healthcare Strategy Becomes Execution.
HLTHWorks is a premier healthcare consulting and execution architecture firm partnering with the industry’s most ambitious leaders—health plans, health systems, and innovators—to transform performance, accelerate growth, and reimagine the future of care.
We do more than advise. We architect and execute the strategies that matter—aligning regulation, clinical operations, technology, and financial performance to deliver measurable impact.
From improving affordability and access to unlocking innovation and operational excellence, HLTHWorks helps organizations move from vision to results.
“$555M in measurable performance impact — Risk Adjustment accuracy, Star quality, network performance, cost of care, and AI transformation — in a single health plan engagement. That is the HLTHWORKS standard.”
— RaeAnn Grossman — Founder & CEO, HLTHWORKS
BUILT FOR LEADERSHIP
We Make Your Vision Executable.
Every executive on your leadership team has a different mandate — and a different definition of performance. HLTHWORKS brings over 100 former healthcare executives to serve all of them, as an intelligent, pragmatic operator partner who has held your role, delivered your outcome, and earned the right to sit across the table from you as a peer.
CFO
Turn AI Investment Into a Defensible Financial Outcome.
You need ROI that holds up in a board presentation — not a strategy deck. HLTHWORKS builds the business case, executes the work, and delivers the financial proof. Star score improvements, Risk Adjustment accuracy and completeness, cost-of-care reduction — in dollars, not percentages.
COO
Operational Execution Where Your Team Runs Out of Runway.
You’re accountable for outcomes across Star, Risk Adjustment, provider engagement, and member experience — simultaneously. HLTHWORKS acts as your senior operational extension: discovering gaps, designing the fix, and deploying alongside your team without disrupting what’s working.
CEO
The Strategic Confidante Who Has Done This Before.
You need a partner who understands the full system — payer economics, provider dynamics, CMS compliance, and AI execution — and can tell you what’s actually broken before it costs you a Star point or $50M in unrecovered RAF.
Chief Data Officer
Your Data Strategy, Activated.
You’ve built the infrastructure. You have the vision. HLTHWORKS connects your data assets to Operational indicators, Star performance, Risk Adjustment accuracy and completeness, and care gap closure in ways that produce measurable outcomes.
CTO / CIO
AI Implementation That Actually Reaches the Clinic.
The gap isn’t your technology — it’s the bridge between your platforms and clinical and operational workflow. HLTHWORKS provides the healthcare domain expertise that makes your AI investments perform: translating technical capability into Star, Risk Adjustment, and care delivery impact.
Chief Actuarial Officer
Risk Adjustment Precision That Protects Your Bid and Your Margin.
Bid work, benefit design, quality recalibration, RAF accuracy and completeness, HCC documentation integrity, bid integrity, and regulatory exposure — HLTHWORKS brings 30+ years of Risk Adjustment execution to your actuarial team. We don’t just identify the gap; we close it.
01
Discover
02
Design
AI-enabled operating models, KPI frameworks, and care pathway redesign built for your reality.
03
Deploy
Execution alongside your team — with measurable milestones, not a slide deck hand-off.
04
Guide
Ongoing retainer partnership to sustain performance, adapt to CMS changes, and scale what works.
Advisory Services
Where Your Performance Gap Becomes a Solved Problem.
HLTHWORKS doesn’t hand you a strategy deck. We discover, design, deploy, and guide — working alongside your team until the financial, operational, and clinical outcome is real and measurable.
AI Execution & Digital Health Performance
Your organization has invested in AI. You have a vision, a roadmap, and probably a vendor or two already under contract. What most health plans, medical groups, labs, and PBMs don’t have is the bridge between technology and clinical and financial performance. That gap — between AI strategy and AI execution — is where HLTHWORKS operates.
Quality, HEDIS & Star Impact Design & Execution
A 0.5 Star score improvement is worth tens of millions of dollars in quality bonus payments and member retention. Most health plans know this. What they lack is the in-year execution capability to actually move the score before the measurement window closes.
Risk Adjustment Center of Excellence
Risk Adjustment accuracy and completeness is not a coding problem. It is an enterprise performance problem — one that touches clinical documentation, provider engagement, data governance, CMS compliance, and your actuarial bid strategy simultaneously.
Regulatory & Compliance Roadmap
CMS doesn’t send advance warning when a regulatory change will materially impact your Star score, your Risk Adjustment revenue, or your compliance posture. HLTHWORKS provides regulatory intelligence and operational readiness planning across Medicare Advantage, Medicaid, and ACA markets.
Network & Clinical Engagement
Your provider network is the primary delivery mechanism for Star performance, Risk Adjustment accuracy and completeness, and clinical outcomes. HLTHWORKS redesigns provider engagement from the ground up — building performance scorecards, clinical pathway alignment, and value-based care accountability structures.
Fractional C-suite & Global Staffing
Executive Leadership and Scalable Operations for Modern Healthcare Organizations. Healthcare organizations are operating in one of the most challenging environments in decades. Rising medical costs, regulatory complexity, workforce shortages, and margin pressure require strong leadership and operational efficiency at the same time.
Who We Serve
Every Organization Built to Perform in Healthcare.
HLTHWORKS serves health plans, health systems, medical groups, PBMs, laboratories, and healthcare vendors — partnering to transform performance, improve margin, ensure scalability, and guide compliance. We bring over 100 senior executives with operating depth across every domain, every market, and every function that matters.
Primary Vertical
Health Plans
All Markets. All Sizes. HLTHWORKS serves health plans across Medicare Advantage, ACA, and Medicaid. Our primary vertical is health plans because it is where we have the deepest operating experience and the most measurable proof of impact.
Vertical
Health Systems
All Markets. All Sizes. HLTHWORKS serves health plans across Medicare Advantage, ACA, and Medicaid. Our primary vertical is health plans because it is where we have the deepest operating experience and the most measurable proof of impact.
Vertical
Medical Groups & ACOs
All Markets. All Sizes. HLTHWORKS serves health plans across Medicare Advantage, ACA, and Medicaid. Our primary vertical is health plans because it is where we have the deepest operating experience and the most measurable proof of impact.
Vertical
Laboratories
From Diagnostic Data to Clinical Performance. Laboratories sit at the intersection of patient care and health plan performance — yet most have never fully activated that position. HLTHWORKS helps laboratory organizations unlock new revenue streams, deepen health plan and provider relationships, and deploy AI & Digital Health enablement that turns diagnostic intelligence into a competitive growth asset.
Vertical
PBMs & Pharmacy
Where Pharmacy Becomes a Performance Engine. PBMs and pharmacy organizations have more direct access to patient behavior than almost any other sector in healthcare — yet that access is chronically underutilized. HLTHWORKS partners with PBMs and pharmacy leaders to transform pharmacy’s role from cost management to clinical performance, growth, and AI-enabled patient engagement.
Vertical
Healthcare Vendors
From Innovation to Performance. Scalable Commercialized. Gaining attention not creating noise. Healthcare vendors face a persistent challenge: their product works in pilots and fails to scale inside health plans, health systems, and medical groups. HLTHWORKS partners with vendors to build the go-to-market strategy, clinical and operational integration framework, and ROI model that makes their innovation sellable — and deployable at enterprise scale.
Assessments
Start Fast.
Deliver Measurable Impact.
Every HLTHWORKS engagement begins with a precise assessment — identifying exactly where your AI investment, Star performance, Risk Adjustment accuracy, and care architecture are leaving financial and clinical outcomes on the table. Six assessments. Each designed for a specific executive challenge.
Performance Diagnostic
The HLTHWORKS Performance Diagnostic is a 4–6 week deep assessment of your organization’s financial, operational, and clinical performance gaps. Output: a CFO-grade roadmap — prioritized by financial impact, implementation feasibility, and organizational readiness.
AI Center of Excellence Assessment – FEATURED
Assess your organization’s AI maturity across data governance, technology infrastructure, operating model, and execution readiness. Identifies where your AI investment is stalled and what it will take to connect it to Star, Risk Adjustment, and care performance outcomes. LEARN MORE →Quality, HEDIS and Star Impact Acceleration Review
A focused assessment of your current Star performance trajectory — identifying the highest-impact HEDIS measures, CAHPS and HOS improvement opportunities, and pharmacy measure gaps within your current performance cycle. Prioritized by financial impact and closure probability. LEARN MORE →Risk Adjustment Accuracy & Completeness Review
A comprehensive assessment of your Risk Adjustment accuracy and completeness across HCC documentation, provider coding patterns, data submission integrity, and CMS audit exposure. Quantifies the revenue gap from incomplete or inaccurate condition capture.
Regulatory Risk Assessment
A targeted assessment of your organization’s regulatory exposure across CMS Medicare Advantage, Medicaid, and ACA requirements. Produces a prioritized risk register and remediation roadmap.
“Pain Points” – Executive Strategy Session
A high-impact 90-minute working session with RaeAnn Grossman and team— structured around your highest-value strategic opportunity or most urgent performance challenge. Not a sales call. A working session where your leadership team leaves with a clear point of view, a prioritized action framework, and a concrete next step.
The Standard
The intelligence briefing healthcare executives read before making decisions.
Six Content Pillars
- AI & Digital Health Execution
- Quality, HEDIS and Star Performance Intelligence
- Risk Adjustment Accuracy & Completeness
- Compliance Regulatory Intelligence and Oversight (including Accreditation)
- Poly-Chronic Care Architecture™
- Private Equity & Venture Capital Intelligence — Where PE & VC are deploying capital in healthcare, which models are attracting investment, and how operators and innovators can position for the next best move.
Subscriber Value
- Financial Execution Intelligence — Star bonus impact, Risk Adjustment accuracy frameworks, AI ROI modeling in CFO language
- AI Implementation Reality — What’s working in health plan AI deployment right now, what’s stalling, and how to close the gap
- CMS Regulatory Signals — 90 days ahead of the compliance event
- Poly-Chronic Care Architecture Insights — Field intelligence on how forward-thinking health plans are redesigning complex member care
- PE & VC Capital Intelligence — Which healthcare sectors are attracting investment, what acquirers are looking for, and how to position your organization for the next value-creation event
- Executive Decision Frameworks — What to prioritize, what to stop, and where to invest
Read by CFOs, COOs, CMOs, and C-suite leaders at health plans, medical groups, labs, and PBMs across the country. No cost. No vendor pitch. Just intelligence.
Podcast
Redesigning Healthcare — Unfiltered
With RaeAnn Grossman
Real conversations with the operators, innovators, C-suite leaders, Private Equity and Venture Capitalists who are actually changing how healthcare delivery and outcomes. No platitudes. No vendor pitches. Just honest intelligence on AI execution, Quality & Star performance, Risk Adjustment accuracy, the next best investment, leadership and the redesign of care — from the people doing the work.