Health Plans
PSG is one of the leading advisors to health plans in the country. Throughout our history, PSG has been working on behalf of health plans (commercial, BCBS licensees, Medicare and Medicaid) to help them protect their interests and achieve best-in-class services in the pharmacy benefit marketplace.
Challenges
We understand the challenges facing health plans today, including:
- Need to control/stabilize costs, yet retain competitive plan designs.
- Balance cost control with member satisfaction.
- Appropriate oversight to ensure compliance with state and federal regulations by outsourced firms (i.e., the PBM function).
- Desire for alternative PBM relationships (e.g., co-sourced, in-sourced, pass-through).
- Significant interest in medication compliance, disease management, wellness, and value-based designs.
- Transient member populations require immediate ROI.
- New CMS pass-through for Medicare Part D will require re-contracting/renegotiation.
Solutions
In order to meet these challenges, PSG has assigned an internal “Practice Leader” with special expertise in this market segment to lead consulting and industry education initiatives to support the unique and complex needs of today’s health plans. Our services to health plans focus especially on:
- Gaining immediate cost control.
- Balancing cost concerns with a focus on the safety, health, and well-being of our client’s member populations.
- Evaluating optimal PBM relationship structures.
- Seeking innovative solutions, in conjunction with selected PBMs, to meet client-specific needs.
- Performing thorough, expert contract/financial negotiations with PBMs.
- Advising on best-practices for plan design and clinical compliance.
- Providing expert advice on CMS requirements and options.
- Providing ongoing oversight services.
Click here to see representative case studies illustrating how PSG has effectively achieved best-value services on behalf of our health plan clients.