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 and Other Senior Markets
Our Senior Market consulting experts, actuaries, and clinicians work closely with Medicare Advantage Organizations (MAOs) and other health plans to capture the opportunity offered by this growing market segment, evaluating the full continuum of alternatives for entry, growth and performance improvement across plan (e.g., HMO, PPO, PACE) and product types (e.g., MAPD, EGWP, SNP). Our clients look to us for expert guidance and a results-oriented approach across a broad range of service areas, such as sales and distribution channel strategies, provider partnership development, risk adjustment support, product strategy and launch, and vendor evaluation and implementation.
Medicaid and Other State-Based Markets
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 have a strong appreciation for the nuanced differences in Medicaid policy and programs across states. We couple this local market knowledge with our deep expertise to support a full spectrum of Managed Care Organization (MCOs) needs, from market evaluation and RFP response to operating model design and implementation, 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., D-SNP, MMP, HIDE-SNP and FIDE-SNP).
Our team is comprised of 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 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.
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.
Our leaders have spent over thirty 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 (DVA), 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, and MOS), the DVA (e.g., CCN), and the OPM (e.g., FEHB, FEDVIP, and PSHB).
Ancillary and Specialty Health Organizations
Ancillary and specialty health organizations look to us as long-lasting strategic partners for their most important initiatives – from corporate growth and diversification to business performance improvement to enterprise transformation.
Our professionals work closely with organizations across the ecosystem, including health plans, stand-alone dental and vision plans, multi-line carriers, and other specialty health entities such as dental service organizations and vision care providers. Our expertise spans a wide breadth of product domains including dental, vision, hearing, life, disability, supplemental health, and a variety of emerging products. We work with clients across all markets (Commercial and Government) and bring a deep understanding of the nuances and keys to success within these markets.
Providers and Health Systems
We work with risk-bearing providers and health systems to develop strategies that enable success in today’s environment with an eye for tomorrow.
Our deep understanding of the key capabilities needed to manage risk, drive population health, and transition to value uniquely positions us to support providers with the development and execution of transformational strategies. We couple our strategic, operational, and clinical expertise with powerful data and analytics to help provider organizations with value-based payment model design, risk-based contracting, partnership development and execution, and other key strategic initiatives.
We bring deep healthcare industry expertise, executive-level industry relationships, and market-leading analytics to provide a differentiated perspective for both contemplated and closed transactions.
Our transaction advisory team provides a full suite of strategic advisory services (Buy Side and Sell Side) for equity and debt investor clients and their portfolio companies, as well as internal corporate development teams. We serve as strategic advisors to a broad range of healthcare entities (health plans, providers, and specialty health organizations) operating in both commercial and government markets, which makes us uniquely positioned to support transactions in nearly every healthcare sector.