Consulting: Medicare & Medicaid

The consultants you'll work with have successfully branded, launched and grown Medicare Advantage plans and Medicaid plans for over 10 years.

Government Programs Operational Compliance

We can help you with key operational performance areas such as: compliance plan; ongoing tracking and monitoring; fraud, waste, and abuse; formulary and benefit administration; transition fills; organization and coverage determinations; appeals and grievances; enrollment and disenrollment; and marketing and sales compliance. We can help with the review and submission of marketing materials and the development and delivery of Medicare Advantage-specific marketing training. We also prepare and submit MA applications and collaborate on bids, provide audit and corrective action plan support, and handle communications with CMS and other regulators.



Whether your organization is new or you've been around for a while, accreditation projects are big jobs.  They require the concerted attention of already-busy cross functional teams. Our accreditation experts have the experience to help you achieve successful accreditation, including NCQA and URAC.  Let us shepherd you through the complex maze of the accreditation process to ensure that your accreditation project is stress free, cost effective, and, most importantly, successful.


Quality Improvement & Star Rating Programs

As payers increasingly rely on quality of care and customer satisfaction scores to shape reimbursement, a sound Quality Improvement Program is more important than ever.   Let us help you build a year-round culture of quality and leverage the industry's best practices to:

  • Increase patient engagement and satisfaction,
  • Achieve better health outcomes and lower costs, and
  • Attain higher scores (in accreditation, HEDIS, CAHPS, HOS)
  • Reach Star Rating goals with strategic recommendations, program management and support
  • Track outcomes and results


Organizational Development Programs

Healthcare is changing at lightning speed.  How can your organization keep up?  From IT implementation projects, to clinical operations improvements, to UM programs, to network strategies; let our experts create organizational development programs that will help you arrive at the answers to these and other complex questions:

  • How can you leverage the healthcare revenue cycle to improve your revenue stream? 
  • What investments should you make in market expansion, network development or additional products? 
  • What is your competitive position in your market?
  • Do you have the optimal team in place to execute your organizational objectives?
  • Is your actual operation and corporate culture aligned with your strategic vision and goals?
  • What can our organization do today to prepare for tomorrow's changing requirements?   


Strategic Planning

Our experts can help you with market analysis; launch preparations; benefit design; network adequacy and strategy, CMS initial and expansion applications, bid and formulary submissions, and go-to market strategies.  We can support your team or handle projects from beginning to end. 


Sales Operations

Is your agent and broker oversight program set up for compliance and success?  Let our experts help you create agent and sales entity oversight programs to manage:

  • Agent appointment process, including training and testing
  • Agent and broker contracts and compensation strategies
  • Agent and broker policies and procedures
  • Sales allegations and compliance incidents
  • Commission payment tracking
  • Enrollment applications
  • Rapid disenrollment
  • Lead management
  • Event management
  • Secret shopper audits
  • Scope of appointment management
  • Sales presentations for events and personal appointments
  • Marketing materials
  • Corrective actions



AEP Advertising Campaigns

Get those Annual Election Period numbers up with fresh, creative and compliant advertising campaigns including direct mail, newspaper ads, TV spots, radio, and more. We'll take care of the copywriting, graphic design, photography, video production, and web design for you.

Special Election Period Campaigns

Need help boosting your enrollment numbers during the off-season? We'll create campaigns to effectively target those age-ins, move-ins, and more.

Marketing Material Creation

As a supplement to your advertising campaigns, it's important to make sure your marketing materials like brochures, business cards, online videos, Summary of Benefits, Provider Directories, and Formularies and more all have the same professional and persuasive look, feel, and voice.

Marketing Material Review

Compliance and accuracy are of the utmost importance to us, as we're sure they are to you. However, when time runs thin and print deadlines are fast approaching, we can help review your marketing, model, and collateral material to catch errors that could result in costly re-prints.

Member Materials

Member newsletters and direct mail campaigns to encourage members to get their screenings are excellent ways to drive your Medicare Advantage plan's five star ratings up. We can help with formulating messages, writing copy and designing the newsletters, flyers, mailers, and anything else you may need to keep your member retention and five star numbers high.

Provider Materials

Provider directories, provider manuals, provider newsletters, affiliation letters, affiliation postcards, and instructional videos to explain electronic claims payment systems are just a few of the many needs that your provider relations team may encounter throughout the year. The good news is that we have extensive experience with all of those things and more.

Employee Materials

Don't let your brand suffer by allowing the quality of your employee newsletters, office flyers, and human resources materials to slip. We work with human resources teams to keep your offices looking as top-notch as all your other materials.

Model Materials

Your model materials like provider directories, formularies, and enrollment forms are often the first impressions that a potential member will get of your brand. We can help with everything from creating the covers of your model materials to formatting the entire documents and making them 508 compliant.

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