Since PHPG's formation, we have specialized in the research, evaluation and reform of state Medicaid programs to assist state governments with reform initiatives for their publicly funded health programs, including Medicaid, Medicare, TRICARE, and correctional health care systems.  PHPG has provided consulting services in over 30 states. 

 

Our services include technical assistance to state legislatures and Medicaid agencies to identify viable options for delivering cost-effective, high-quality services under managed systems of care.  PHPG associates have assisted state and county government clients across the country to evaluate their existing programs and undertake reforms to:

 

• Expand access to health coverage for low-income workers and their families

• Develop managed systems of care for Medicaid and CHIP beneficiaries, including long-term care recipients

• Design specialized programs for behavioral health care and school-based services increase federal financial participation, through innovative waiver programs and reimbursement system

• Contain costs, while preserving essential services, through restructuring of provider payment rates

 

We have participated in development of some of the most innovative and successful Medicaid and payment reform models in the nation.  PHPG’s range of public sector engagements have included program eligibility development, benefits and service delivery modeling and provider payment methodology development.  More specifically, PHPG has worked on behalf of twelve Section 1115 waiver states that include Arizona, Florida, Illinois, Maine, Maryland, New Hampshire, New Mexico, New York, Oklahoma, Rhode Island, Tennessee and Vermont.  PHPG also has provided managed care-related assistance to the states of California, Georgia and West Virginia for their Section 1915b managed care programs.

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Additionally, PHPG has assisted private issuers in a variety of activities related to plan development, benefit and rate development, fulfillment of CMS and other federal requirements and state market-specific insurance requirements.  Our activities have covered all facets of system reform planning, development, program implementation, and evaluation. 

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Our services have included:

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• Operations management

• Financial management

• Competitive procurements

• Performance monitoring

• Specialized initiatives for populations with special needs

• Program and product development

• Technical assistance in development of all aspects of managed care programs for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries

• Program readiness reviews

• Program evaluations/audits