© Pelorus Management Consultants LLC August 2013
Government Programs: We help clients implement the requirements of managed Medicare and Medicaid programs. This includes both medical and pharmacy programs and Part C Special Needs Plans. These programs require unique provider contracts, patient access, quality improvement, operations, reporting, compliance and information system requirements. We have helped clients complete applications and proposals for entry, as well as develop internal auditing programs to support compliance.
Health Care Reform: We assist health plans with the implementation of the Health Care Reform law and in particular, the Health Insurance Marketplaces. We work with health plans to develop implementation business strategies and project plans to operationalize the products within the Exchanges in their states. This includes helping clients expand geographically and with new products.
Project Management and Project Planning: We assist clients in the area of project management by helping them establish a project management office (PMO) in their organization. We have also assumed direct responsibility for the development of project plans and the management of projects. Our responsibilities often include mentoring health plan staff, so they own the projects once we leave.
Turnaround and Transition Support: We understand and have addressed the core issues that need to be resolved to turnaround a troubled managed care organization (payers or “at risk” providers, such as Accountable Care Organizations). Engagements have included overseeing the sale of a company or asset (i.e., membership) and the outsourcing of functions during the wind down process.
PMC consultants are able to assume executive and management roles during transition engagements or when this assistance is needed by an entity on a temporary basis. These roles include serving as CEO, COO, CIO and CFO.
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.