Regulatory, Compliance, and Accreditation advisory

Overview

Legislative and regulatory decisions lend to complex requirements in healthcare and government offerings.  Healthcare organizations, state, and federal agencies are put in the position to implement, oversee, and monitor multi-faceted programs, often with little to no resources or healthcare regulatory knowledge on the staff.  Illuma Advisors has extensive strategic, regulatory, legislative, operational, and developmental knowledge in healthcare offerings and benefits that can amplify your oversight and programs.  We harness our experience to work with you as an extension of your team and to empower your team to continue to offer the best programs and services.

Case studies

Critical Knowledge Transfer: We collaborated with a government agency to conduct a comprehensive evaluation of their healthcare exchange options. Our analysis scrutinized various benchmarks, which we then compared to plans from other states and territories. This included a focus on specific diseases and the formulation of recommendations for improvement. Additionally, we provided educational support to the team, and created rigorous standard operating procedures for the effective review of plans available on their exchange. As a result of our collaboration, the state experienced enhanced regulatory oversight and improvements in the clinical services offered.

Enhancing Regulatory Compliance: Illuma Advisors team collaborated with a PBM to ensure that their offerings met state and federal requirements for PBMs as well as were sufficient to attain URAC accreditation. Our team of advisors worked closely with the client to prioritize and evaluate legislation in all states where they were licensed and evaluated if those requirements were implemented in their offerings. Additionally, we reviewed URAC standards and prepared for URAC accreditation review to ensure that the PBM would be able to pass URAC accreditation. As a result of our collaboration the client has enhanced their offerings, oversight, and processes to ensure they offer state of the art benefits and services to their clients.

Bridging the knowledge gap: A state agency sought to deepen their understanding of healthcare options available within their jurisdiction. At Illuma Advisors, we leveraged our unique blend of experience and research acumen to compile a comprehensive report. Our findings not only met but exceeded the agency's expectations, highlighting specific areas requiring further scrutiny and offering actionable recommendations. Through seamless collaboration with their team, we identified multiple avenues for impactful change, ultimately enabling the state to refine and enhance its healthcare offerings.