PCG’s Health practice offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes.

What We Do

For State Health & Medicaid Agencies

See how we can help you increase program revenue, cut costs, and improve compliance with state and federal regulations.

For State Insurance Departments

Let us help you navigate the regulatory landscape, including the Affordable Care Act (ACA), and implement changes and new requirements with confidence.

For Provider Organizations

Boost your financial performance and compliance with our proven approach to improving claiming practices and operations management.

For Health Plans

Optimize your plan’s performance and compliance without sacrificing patient outcomes with our program integrity services.

News & Perspectives

States Pursue Unique Approaches to Permit Non-Compliant Health Plans

Today

While much of the attention over the debate over the Affordable Care Act (ACA) has centered at the Federal level, states continue to act as the laboratories for innovation. Last year Health Policy News featured a series of updates on activity around Section 1332 State Innovation Waivers in the states – with a focus primarily on State-based reinsurance and invisible high risk pool mechanisms.  That activity continues – though at a slower pace – with the recent waiver request submitted by Wisconsin.

ReadMore

Movement on drug cost containment at both the State and Federal level

Today

Health Policy News has devoted significant attention to State and Federal efforts to contain drug costs, including recently issuing a report and legislative tracking tool entitled “ Rising Prescription Drug Costs: A report on state and federal efforts to contain costs”. As we head into the summer we offer readers a few short updates on some of the issues we have been closely following and will continue to track...

ReadMore

Looking to the Future of Workers Compensation

Today

Several members of the PCG Health team recently attended the Workers Compensation Research Institute’s Annual Issues & Research Conference in Boston. The conference convenes researchers, regulators, and other workers’ compensation professionals from around the country to discuss trends they are seeing within the industry...

ReadMore

Illinois Wins CMS Approval for Medicaid Behavioral Health Services Innovation

14 days ago

On May 7, 2018, Illinois Governor Bruce Rauner announced that Illinois has won federal approval to launch a 5 year, $2 billion Medicaid behavioral health services initiative.  The initiative will be implemented by the Illinois Department of Healthcare and Family Services in collaboration with the Governor’s office and eleven other Illinois state health and human services agencies.  Objectives of Illinois’ initiative include...

ReadMore

Mitigating the Loss of the Individual Mandate- State Based Health Insurance Mandates

28 days ago

In December 2017, the federal administration’s tax bill – the Tax Cuts and Jobs Act, phased out the individual mandate requirements, with the penalty for failing to have qualified insurance eliminated starting in 2019. For 2018, the mandate remains, with the penalty set at $695 per adult or 2.5% of household income, whichever is higher.  The individual mandate is cited as one of the tenants of the success of the Affordable Care Act. In order to ensure a healthy risk pool, participation of as many individuals as possible was key.

ReadMore

CMS Releases Final Exchange Guidance

28 days ago

On April 9, 2018, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final Exchange guidance for the 2019 plan year – the final Notice of Benefit and Payment Parameters for 2019 (NBPP) and the final Letter to Issuers in the Federally-facilitated Exchanges (Letter). Together, the NBPP and Letter set forth changes to rules and operational and technical guidance for health plan regulation, Exchange operations (including plan certification and financial parameters), and premium stabilization programs. Most–but not all–of the changes take effect for the 2019 plan year.

ReadMore

Meet Our Team

team-member

Jay Peck

Associate Manager / Health

Mr. Peck has been with PCG for over 13 years, specializing in Medicaid Program Integrity, Quality Improvement, and Beneficiary Due Process. He has successfully led the implementation of large-scale projects, such as a Provider Oversight effort in Ohio...

ReadMore
team-member

Peter Cheesman

Associate Manager / Health

Mr. Cheesman leads PCG Health's Member Eligibility Solutions group. In this capacity, he has overseen the implementation and operation of high-profile benefits eligibility verification systems and data broker solutions for health and human services...

ReadMore
team-member

Dale McCourt

Associate Manager / Health

Mr. McCourt, Associate Manager, has been a member of the PCG team since 2011. Dale brings over 25 years of experience spanning many industries where he has served in a variety of roles including Chief Operating Officer, Project Manager, Manager...

ReadMore
team-member

Tony Curatola

Associate Manager / Health

Mr. Curatola, an Associate Manager with PCG and certified PMP, has more than 29 years of experience in the Information Systems industry with over 22 years in project management and 18 years in Medicaid.  He has extensive project management experience in both the public and private sectors including: state government, property and casualty Insurance, healthcare insurance, and banking.

ReadMore
team-member

Kevin Hutchinson

Manager / Health

Mr. Hutchinson oversees PCG's Program Integrity and Provider Management solutions, advising and aiding Medicaid agencies and healthcare care plans in improving compliance and quality, while preventing fraud, waste, and abuse. He leads a team that provides...

ReadMore
team-member

Tom Entrikin

Manager / Health

Mr. Entrikin has 45 years of experience with the Medicaid and Medicare programs. From 1981 to 1992, he was a Medicaid policy specialist with the US Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS)...

ReadMore
team-member

Lisa Lee

Associate Manager / Health

Ms. Lee has been with PCG for 1 year and helps lead the Health Innovation, Policy and Information Technology Center of Excellence, specializing in Medicaid, CHIP, and ACA policy. Project accomplishments include the creation of Mississippi’s 1115 Waiver Application...

ReadMore
team-member

Rick Dwyer

Manager / Health

Mr. Dwyer, a Manager located in our Boston office since 1993, has over thirty years of experience in financial and operations management in corporate and healthcare provider and payer environments.  For providers, Mr. Dwyer has been actively involved...

ReadMore
team-member

Kelly Gallagher

Associate Manager / Health

Ms. Gallagher has been with PCG for 10 years. Ms. Gallagher helps lead the Cost Allocation Center of Excellence, specializing in cost allocation, time studies, Medicaid and Title IV-E claiming programs, business process review, Targeted Case Management (TCM)...

ReadMore
team-member

James Waldinger

Associate Manager / Health

Mr. Waldinger, an Associate Manager at PCG, is an experienced Medicaid policy and reimbursement professional who focuses on healthcare operations, mental health and substance abuse policy and integration, and health care reform and its impact on Medicaid programs and providers.

ReadMore
team-member

Shawn Kotoske

Director of Internal Administration / Health

Mr. Kotoske has significant experience in leadership, project management, policy analysis, application development, and data analysis. In 2014 he created the Health Project Management Office (PMO), and now directs the PCG Health Internal Administration Office...

ReadMore
team-member

John Blowers

Associate Manager / Health

Mr. Blowers leads the newest PCG Health Center of Excellence known as Staffing Solutions Organization (SSO). While SSO just celebrated its one-year anniversary on May 1st, Mr. Blowers has over 25 years of HR experience...

ReadMore
team-member

Joe Weber

Associate Manager / Health

Mr. Weber, PMP, has been with PCG for 13 years. Mr. Weber helps lead the Health Care Financing Solutions (HCFS) Center of Excellence with over twelve years of public sector consulting focusing on publicly funded healthcare programs including Medicaid...

ReadMore
team-member

Rich Albertoni

Manager / Health

Mr. Albertoni has 16 years of experience working in state public health programming and Medicaid. He has held leadership positions in eligibility, budget and finance, and benefits and waivers.

ReadMore
team-member

Sean Huse

Manager / Health

Mr. Huse (MBA, CHFP), a Manager at Public Consulting Group, is an experienced health management consultant who focuses on financial management, strategic planning, policy analysis, information...

ReadMore
team-member

Aaron Holman

Associate Manager / Health

Mr. Holman has been working in health policy for the past decade, starting in the United States Senate working on Medicare, CHIP and Health IT areas for Senator Debbie Stabenow (D-Michigan) and the Finance Committee. Mr. Holman also worked as a lobbyist in Washington focusing on health IT financing and standards development...

ReadMore
team-member

Kevin Carlson

Chief Technology Officer / Health

Mr. Carlson has more than 20 years of experience in the health care technology sector. He has overseen the development and implementation of numerous electronic health record, revenue cycle management (RCM), business intelligence, and health...

ReadMore
team-member

Matthew Sorrentino

Manager / Health

Mr. Sorrentino, a Manager and Center of Excellence (COE) lead for our Healthcare Financing Solutions division, is a management consultant with 15 plus years of extensive Medicaid and healthcare experience.

ReadMore
team-member

Marc Staubley

Associate Practice Area Director / Health

Mr. Staubley is PCG Health’s Associate Practice Area Director (APAD) and a PCG shareholder.  In this role, he provides executive leadership to over 400 staff who manage a portfolio of over 200 projects that span across more than 35 states...

ReadMore
team-member

John Shaughnessy

Practice Area Director / Health

Mr. Shaughnessy is Director of PCG Health. He joined the firm in 1992 and has extensive experience in operations improvement, strategic planning, and revenue maximization consulting for hospitals and others such as health care providers...

ReadMore