Health plans and payers
We work across the health plan landscape—national, regional/statewide, provider-sponsored, and smaller niche plans—to solve complex problems and unlock new opportunities across all market segments.
Medicare
Our senior market consulting experts work closely with Medicare Advantage Organizations (MAOs) and other health plans to capture the opportunity offered by this market segment, evaluating the full continuum of alternatives for entry, growth, and performance improvement. Our clients look to us for expert guidance and a results-oriented approach across a broad range of services, such as product strategy and launch (e.g., SNP, EGWP), new market/service-area expansion, sales and distribution channel strategies, provider partnership development, network strategy and value-based care enablement, Star ratings and risk adjustment support, premium and payment integrity, and vendor evaluation and implementation.
Medicaid
We are recognized leaders in helping health plans evaluate, enter, and optimize performance in Managed Medicaid markets. Having worked across nearly all Medicaid markets, we appreciate the nuanced differences in Medicaid policy and programs across states. We couple this local market knowledge with deep expertise to support a full spectrum of Managed Care Organization (MCO) needs—from market evaluation and RFP response to operating model design, implementation/readiness review support and overall performance optimization—as plans evolve to meet enhanced state expectations for supporting critical populations (e.g., I/DD, LTSS, HCBS) and greater integration with Medicare programs (e.g., MMP, HIDE-SNP, FIDE-SNP)
Commercial
Our team comprises former health plan executives and industry leading consultants that have spent their careers running or supporting commercial health plans. We understand the unique challenges and differences between large group Administrative Services Only (ASO) business and other group business, as well as the pressure plans are under to customize, competitively price, and offer solutions to meet the demands of their employer group customers. Our team works with plans to optimize performance in these highly competitive markets.
Individual
Our team has helped clients navigate the complex and continuously evolving dynamics in the Individual market since the establishment of the state and federal health insurance exchanges in 2014. We support clients with market evaluation and entry, product design and filings, as well as ongoing operations and risk management strategies needed to enable long-term financial viability.
Federal
Our leaders have spent 30+ years advising clients with the development and execution of successful federal program strategies for the Centers for Medicare and Medicaid Services (CMS), Department of Defense (DoD), Department of Veterans Affairs (VA), and other federal agencies. We help clients bid, win, implement, enhance, and protect federal healthcare contracts of all sizes, including but not limited to those offered via CMS (e.g., MAC, MIDS), DoD (e.g., MCSC, TDP, TPharm, MFLC and MOS), VA (e.g., CCN), and OPM (e.g., FEHB, FEDVIP, and PSHB).
Related insights
