We partner with financial institutions across the investment lifecycle to help them unlock value, accelerate performance, and improve health outcomes. Whether you’re evaluating an acquisition, scaling a portfolio company, or preparing for a strategic exit, HLTHWorks provides tailored support focused on:

• Population health strategy
• Payment integrity optimization
• Value-based care readiness
• Healthcare insurance simplification
• Medical cost containment
• Care navigation and network alignment
• Risk adjustment compliance and accuracy
• Quality score performance improvement
• Efficiency planning
• Technology enablement 
• Actuarial strategic execution design

Case Study 1:

Lifting Star Scores from 3.5 to 4.5 in 13 Months

One national Medicare Advantage plan turned to HLTHWorks to reverse a multi-year trend of stagnant Star performance. Through a targeted 13-month execution plan and a realignment of the organization’s governance model, HLTHWorks helped the client raise their overall Star rating from 3.5 to 4.5. The initiative focused on closing care gaps in real time, aligning clinical and quality teams, and embedding data-informed action at every level of the enterprise. The result: a significant increase in member retention, higher quality bonuses, and improved clinical outcomes. Healthy happier members, teams, boards, and investors.

Case Study 2:

Raising Risk Adjustment Accuracy — RAF Score From 0.87 to 1.1

For another client, HLTHWorks designed and implemented a more compliant and robust risk adjustment strategy. By improving provider documentation, streamlining coding processes, and enhancing true, present HCC recapture with detailed analytics, the health plan’s average RAF score improved from 0.87 to 1.1. This shift resulted in better alignment with member acuity, provider care protocols and generated millions in sustainable revenue—without triggering audit risk due to the clear clinical treatment plans and better medical management and outcomes.

Case Study 3:

Reducing Costs with Smarter Network & Navigation Design

A third client, struggling with escalating medical costs, engaged HLTHWorks to assess and redesign their provider network, care pathways, and member navigation processes. Our team implemented streamlined, patient-friendly access models and guided care coordination pathways that made it easier for members to get the right care at the right time. The results were significant: 23% reduction in inpatient costs and 12% reduction in outpatient expenses—all while improving member experience, outcomes and satisfaction.

Why It Matters for Investors

These results aren’t just good for patients—they’re good for business. In a healthcare environment where performance metrics, member outcomes, and regulatory compliance directly impact valuation and ROI, execution matters. HLTHWorks helps clients go beyond being an investor to become catalysts for real, measurable improvement in healthcare delivery.