States are at the forefront of transformative changes that impact how health care is accessed, delivered, managed, and reimbursed. These changes require strategic thinking, thoughtful planning, and effective tactics. We lead the field in providing consulting services that help state agencies to implement the Affordable Care Act, with a unique broad expertise in both policy and operations. PCG Health offers state insurance departments a variety of services and tools to successfully plan for and implement health care reforms.
With the introduction of health insurance marketplaces (Marketplaces) and federal regulatory requirements, state plan management has become increasingly complex. With long-standing experience in both the policy and operational ends of this work, PCG assists state insurance departments to effectively manage insurance plans, with comprehensive services that start with policy development and plan review and continue through ongoing management.
Under the Affordable Care Act as well as recently proposed federal regulations, there are new requirements for greater transparency and justification for significant rate increases, with increased scrutiny of this process, as regulators endeavor to ensure both that health plans are sufficiently capitalized in order to meet claims payment obligations and the reasonableness of rates. Our subject matter expertise and deep understanding of state insurance department practices enable us to effectively support states' effort to enhance their overall rate review program.
The regulatory landscape of health coverage shifts constantly and the work of state insurance departments are directly impacted by these developments. Our legal and policy experts help guide clients through those changes to keep them fully informed of the latest developments.
As the commercial insurance marketplace continues to evolve, insurance departments are trying to identify issues in carrier-provider contracts that could be major drivers of total medical expense growth and impact the state's ability to monitor and regulate rate increases. PCG assists with comprehensive reviews that are informed by our broader rate review work.
For PCG Health, Ms. Kaplan Howe has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze, and lead strategic consideration of federal opportunities and requirements. She currently leads the PCG team assisting the New Hampshire Insurance Department with continuity of coverage related to the Marketplace and the state's premium assistance program and has assisted with the state's health insurance marketplace plan management work.
Ms. Thistle has extensive experience consulting on health insurance marketplace (Marketplace) policy garnered through her work leading the operational and policy planning for the state-based Marketplace in Vermont, as well as her work on the New Hampshire partnership marketplace. She provided policy, legal, and technical support for all Marketplace requirements as a member of the Vermont Health Connect policy team, and served as the lead presenter to the Centers for Medicare & Medicaid Services for all plan management requirements and functionality.
For more information about PCG Health's Health Policy and Regulatory Support Services please contact us at firstname.lastname@example.org or 1-800-210-6113.