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📘 Question

34-1

MedBridge Health is a mid-size managed care organization operating across seven states with 1.4 million members. New federal regulations require MedBridge to overhaul its prior authorization processes, implement digital systems, and meet strict new turnaround and approval rate standards within 18 months or face penalties and potential loss of CMS contracts. Bain has been engaged to design a compliance strategy that meets requirements while minimizing cost and disruption.

Before reviewing any data, how would you structure the path to compliance?

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MedBridge Health is a mid-size managed care organization operating across seven states with 1.4 million members. New federal regulations require MedBridge to overhaul its prior authorization processes, implement digital systems, and meet strict new turnaround and approval rate standards within 18 months or face penalties and potential loss of CMS contracts. Bain has been engaged to design a compliance strategy that meets requirements while minimizing cost and disruption.

Before reviewing any data, how would you structure the path to compliance?

Click the audio to listen to the question.

📊 Case Exhibit

Use the exhibit to answer the above question.

Your answer:

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