PMC can assist clients in a wide array of areas including:

Turnaround and Transition Support:  We understand and have addressed the core issues that need to be resolved to turnaround a troubled managed care organization (payors or “at risk” providers) – provider contracting, regulatory relations and compliance, pricing/underwriting, member retention, operations assessment and improvement. Engagements have included overseeing the sale of a company or asset (i.e., membership) and the outsourcing of functions during the wind down process.  These activities required a detailed understanding of State and Federal regulatory requirements.  PMC consultants have assumed executive and management roles, as needed, during transition engagements.  These roles have included serving as CEO, COO, CIO and CFO for health plans.

Medicare and Medicaid:  We understand the unique member and regulatory requirements of managed Medicare and Medicaid programs.  This includes both medical and pharmacy programs, including the Part D Prescription Drug Program and Part C Special Needs Plans. These programs require unique provider contracts, patient access, quality improvement, operations, reporting, and information system requirements.  Success in serving government programs requires a focus that we have helped clients develop.  We have assisted clients in obtaining certification as a Medicare plan, and we are working with clients to address the opportunities under the Medicare Advantage program.

Operational and Readiness Assessments: We have conducted both operational and financial assessments of managed care organizations at the request of owners and senior executives.  We follow a process similar to a due diligence review and provide our opinion of the organization's strengths and weaknesses.  This is often done as a prelude to a turnaround, operations improvement process, sale or strategic planning process. 

Process Improvement and Change Management:  We have assisted a number of clients in evaluating and improving their core functions.  In particular these have included customer service, call center management, information systems management, medical management and provider relations/contracting.  Clients obtain service quality improvements and increased efficiency.

Vendor Initiatives.: We have assisted in the selection, implementation and management of various vendors that provide services to health plans.  This includes making the relationship work effectively and efficiently to the benefit of members and providers.  Topics have included PBMs, medical carve-out agreements (lab, behavioral health), disease management programs, document management, EDI, predictive modeling, and provider profiling.

Project Management:  We have assisted clients by taking over direct project management roles.  For organizations with a number of key initiatives, this can include establishing a project management office (PMO).  We would generally assume direct management responsibility for a period of time and then turn over management to an individual hired by the client.  Even after the transition we have commonly continued with an oversight role for some period of time.  In a number of cases, our role included coordinating the activities of other consulting firms.

Information System - Selection and Implementation:  We help clients identify, acquire, and install the best information system to address their needs.   This includes requirements development, vendor identification and selection, contracting, project planning, testing and implementation.  PMC has taken the lead role and worked with client personnel or taken on an advisor-counseling role supporting the client's project leader.  Project scope can include replacing the core applications or selected topic areas (i.e., profiling, HEDIS, medical management, customer service, document management or workflow management). 

E-Health and E-Commerce:  Many managed care organizations are seeking help in how to best use the Internet and the networked world in which we now live.  We have assisted clients in developing and implementing web based self-service capabilities for providers, members, employers and brokers.  During the next few years we look to also assist clients in the use of the Internet to support health care service delivery.  There are a number of innovations (i.e., provider to patient email communication) that will improve the quality and efficiency of health care information and services.

Revenue and Payment Management:  We have assisted payors in revenue management and payment management activities.  From a revenue viewpoint this includes reviewing underwriting, rating and pricing approaches. This includes the methods used when contracting with commercial plan sponsors, as well as, government programs (Medicare and Medicaid). 

From a payment management viewpoint this includes the various methods (fee for service, capitation, incentives) used to pay providers for their services.  This includes an understanding of contracting approaches, service coding and claim payment policies.  Our knowledge base includes expertise in the fee for service payment approaches used by Medicare and Medicaid and how those approaches are used in government programs and how they are adopted for use in commercial programs.

Market Research:  Building from our broad expertise in health care, we are able to assist a variety of players with market research activities.  This includes helping investors assess opportunities, assisting payers and suppliers with product development and portfolio investment decisions, and advising providers on service creation options. 

Seminars and Training: As an outgrowth of our consulting services we have developed customized seminars and training programs.  These can address many of the topics listed in the services section of this web site –  Medicare, Medicaid, change management, quality improvement, and managed care business models.