Diagnose. Prioritize. Transform.

Healthcare organizations today face unprecedented financial pressure, regulatory scrutiny, and operational complexity. Many leadership teams recognize performance gaps but lack the time, independent perspective, or analytics required to fully diagnose root causes.

HLTHWorks Assessments provide rapid, data-driven evaluations of the operational, clinical, regulatory, and financial drivers that determine organizational performance.

Our assessments are designed for Boards, CEOs, CFOs, Chief Medical Officers, Chief Strategy Officers, Department Leads and Compliance Leaders seeking clear answers to critical questions:

• Where are we losing revenue or margin?
• Are we exposed to regulatory risk?
• Are our clinical and operational programs performing as expected?
• Which transformation initiatives should we prioritize?

Each HLTHWorks assessment delivers clear executive insights, quantified financial impact, and a practical transformation roadmap.

Our assessments cover:

AI Readiness and Healthcare AI Roadmap Assessment

Evaluates the maturity and sophistication as an organization deploys artificial intelligence across clinical, operational, and financial functions.

Focus Areas
  • AI governance and regulatory risk
  • Data infrastructure readiness
  • Clinical decision support opportunities
  • Revenue cycle and operational automation
  • Predictive analytics capabilities
Outcome

A practical AI roadmap aligned with regulatory requirements and financial ROI.

Accreditation Assessment

Prepares organizations for NCQA, URAC, Joint Commission, and other accreditation reviews.

Focus Areas
  • Governance structures
  • Policy and regulatory alignment
  • Documentation and reporting processes

  • Quality program maturity
Outcome

Gap analysis and readiness roadmap to ensure successful accreditation and minimize compliance risk.

Compliance and Regulatory Oversight Assessment

Evaluates an organization’s compliance framework and exposure to regulatory audits.

Focus Areas
  • CMS regulatory compliance
  • RADV readiness
  • Fraud, waste, and abuse controls
  • Compliance governance structures
Outcome

Strengthened oversight and reduced regulatory risk.

Provider Network Performance Assessment

Examines whether provider networks are delivering value in terms of cost, quality, and access.

Focus Areas
  • Network adequacy and access
  • Provider performance variation
  • Value-based contracting alignment
  • Referral and leakage patterns
Outcome

Strategic network optimization and contracting recommendations.

Medical Cost and Utilization Assessment

Identifies drivers of rising medical expense and opportunities to improve utilization management.

Focus Areas
  • Inpatient and emergency department utilization
  • Care management effectiveness
  • High-cost patient populations
  • Pharmacy cost drivers
Outcome

Targeted strategies to reduce avoidable utilization and improve care coordination.

Benefit Design and Product Strategy Assessment

Evaluates whether health plan products and benefit designs are aligned with market demands and financial sustainability.

Focus Areas
  • Competitive benefit analysis
  • Cost-sharing structures
  • Supplemental benefits strategy
  • Product profitability
Outcome

Optimized product offerings and benefit structures that improve both competitiveness and financial performance.

Product Roadmap and Market Growth Assessment

Evaluates future product strategy across Medicare Advantage, Medicaid, Commercial, and value-based care models.

Focus Areas
  • Market expansion opportunities
  • Product innovation strategy
  • Competitive positioning
  • Revenue growth potential
Outcome

A clear product roadmap for sustainable growth.

Quality Performance Assessment (HEDIS & Star Programs)

Analyzes quality performance and opportunities to improve Star ratings and clinical outcomes.

Focus Areas
  • HEDIS measure performance
  • Star bonus optimization
  • Care gap closure processes
  • Member & Clinical engagement
Outcome

Strategies to improve quality scores and maximize bonus revenue.

Risk Adjustment Performance Assessment

Evaluates the accuracy and effectiveness of risk adjustment programs.

Focus Areas
  • Documentation and coding accuracy
  • Provider engagement strategies
  • Data integration and analytics
  • RADV audit readiness
Outcome

Improved revenue accuracy and reduced audit risk.

Member and Patient Experience Assessment

Evaluates the factors driving satisfaction, engagement, and patient outcomes.

Focus Areas
  • CAHPS performance
  • Digital experience and access
  • Care coordination effectiveness
  • Communication strategies
Outcome

Improved member experience and stronger quality performance.

Member Retention and Growth Assessment

Identifies factors influencing membership growth and retention.

Focus Areas
  • Disenrollment drivers
  • Competitive positioning
  • Member engagement strategies
  • Market expansion opportunities
Outcome

Improved retention and long-term membership growth.

Culture and Staff Engagement Assessment

Evaluates organizational culture and its impact on performance and transformation readiness.

Focus Areas
  • Leadership alignment
  • Employee engagement levels
  • Communication effectiveness
  • Change readiness
Outcome

Strategies to strengthen culture and support organizational transformation.

Workforce Strategy and Outsourcing Assessment

Evaluates staffing models and identifies opportunities for operational efficiency.

Focus Areas
  • Workforce productivity
  • Offshore staffing opportunities
  • Operational scalability
  • Talent gaps
Outcome

Cost-efficient staffing models that improve operational performance.

Vendor Performance and ROI Assessment

Evaluates the value delivered by technology, analytics, and service vendors.

Focus Areas
  • Vendor cost vs performance
  • Contract effectiveness
  • Technology utilization
  • Redundancy and overlap
Outcome

Improved vendor ROI and stronger vendor governance.

Interoperability and Data Integration Assessment (FHIR / ECDS)

Evaluates data connectivity across clinical, claims, pharmacy, and operational systems.

Focus Areas
  • FHIR API readiness
  • ECDS reporting capability
  • Data architecture integration
  • Interoperability compliance
Outcome

Integrated data infrastructure that supports analytics and regulatory reporting.

Deep Dive Strategic Assessments

  • Executive Performance Control Tower Assessment
    Evaluates how effectively leadership teams monitor financial, clinical, and regulatory performance.
  • Value-Based Care Readiness Assessment
    Evaluates readiness for ACOs, bundled payments, and shared savings models.
  • Pharmacy Strategy Assessment
    Analyzes specialty pharmacy spend, formulary strategy, and medication management programs.
  • Revenue Recovery Assessment
    Identifies hidden revenue opportunities across quality, risk adjustment, utilization, and operational performance.
  • Healthcare AI Regulatory Risk Assessment
    Evaluates governance and compliance risks associated with AI deployment.

The HLTHWorks Assessment Approach

Every HLTHWorks assessment includes:
  1. Data analysis and leadership interviews
  2. Benchmarking against industry best practices
  3. Financial impact modeling
  4. A prioritized transformation roadmap
Most assessments can be completed in 4–12 weeks and often uncover tens of millions in financial opportunity.

The Result

Healthcare organizations that complete HLTHWorks assessments gain:
  • Clear visibility into performance gaps
  • Reduced regulatory exposure
  • Improved financial performance
  • A practical roadmap for transformation

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HLTHWorks partners with healthcare leaders to identify hidden opportunities, reduce risk, and unlock sustainable growth. 

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