State Medicaid agencies are at the forefront of transformative changes that impact how health care is accessed, delivered, managed, and reimbursed. These changes require strategic thinking, thoughtful planning, and effective tactics.
Public Consulting Group (PCG) has provided effective, results-driven management consulting to state agencies for more than 25 years. Our PCG Health division played an active role in helping many state agencies to implement the Health Insurance Portability and Accountability Act, the Welfare Reform Act, No Child Left Behind, and Medicare Part D. PCG Health now leads the field in providing consulting services that help state agencies to implement the Affordable Care Act (ACA). How can we help your agency?
Health Care Reform requires major changes to health related policies, programs, and operations for all states. Big changes require frequent, accurate, high impact, and open communications with state and community leaders, consumers, public coverage program members, advocacy organizations, insurance issuers, business owners, and other key stakeholders. The requirement to provide one-stop shopping requires designing and implementing consumer-friendly, highly efficient, multi-channel contact center solutions that connect consumers to insurance products cost-effectively and accurately.
One major and recurring theme of health care reform is the goal of care coordination and patient-centered health. Patient Centered Medical Homes (PCMH) and Medicaid Health Homes are two key channels for achieving this goal. State agencies, health coverage issuers, and providers can realize tremendous value by supporting these initiatives, simultaneously driving improvements in both the quality and cost of care for their communities.
PCG is a leading consultant to states on Health Insurance Exchange establishment. We are experts at Partnership model planning and implementation. Our detailed knowledge of the ACA helps us assure that state Exchange systems are being built consistent with federal rules. We are working with state health and insurance department staffs to build a protocol for Exchange operations.
PCG helps states assess the value and operation of their Medicaid managed care programs. Our team is uniquely qualified to assess the enrollment, plan design, network development, business processes, quality reporting, and analytics of managed care plans. PCG will continue to serve as a trusted advisor for states looking to adapt Medicaid delivery systems to achieve utilization and cost control.
Regardless of your state’s policy on Medicaid expansion or model for a Health Insurance Exchange, national implementation of the Affordable Care Act (ACA) will affect your state’s Medicaid program. Some impacts are a direct result of new Medicaid requirements. Other impacts will come about indirectly as non-Medicaid ACA requirements are implemented.
PCG continues to work with states to develop their State Medicaid Health Information Technology Plan (SMHP). These efforts include the development of an implementation plan for Electronic Health Records (EHR) and Provider Incentive Payments (PIP).
PCG has long helped states assure full claiming of eligible federal matching funds. Now we are helping states stay on budget through innovations such as Medicaid coordination with veterans' benefits.
Ms. Paterson brings significant state Medicaid regulatory experience to her role at PCG, having served as Acting Medicaid Director and Bureau Chief, Medicaid Policy for the state of New Hampshire prior to joining the firm. At PCG, she has provided quality assurance analysis and services to the state of Maine, Department of Health and Human Services, and state of New York, Department of Health. She also participated in the independent verification and validation (IV&V) of the Medicaid Management Information Systems (MMIS) for the state of New Hampshire’s Department of Health and Human Services, providing evaluation of the general system design.
Mr. Waldinger, a associate manager in our Boston office, focuses on Medicaid policy, analysis and implementation. He has extensive experience in state and Medicaid budgeting and finance, having served as Chief Financial Officer (CFO) and Budget Director for the Massachusetts Medicaid program, MassHealth, and, more recently, as CFO for the Massachusetts Behavioral Health Partnership, which managed the behavioral health needs of more than 300,000 Medicaid members.
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For more information about PCG's Health Care Reform services please contact us at
firstname.lastname@example.org or 1-800-210-6113.