Health plans are being challenged like never before. Our payer consulting team advises health plans in the development of effective strategies to build partnerships, grow membership, and manage cost of care in both government programs and commercial products.

Health Plan Consulting

Even the most agile health plans are struggling to adapt to legislative mandates and the rise of mega-insurers resulting from rapid consolidation. Building market share across product designs, scaling up to ensure cost-effective operations, and managing population health initiatives are just a few of the most pressing issues keeping payer leadership awake at night.

ECG advises traditional and provider-owned health plans across the spectrum, including Medicare Advantage, Medicaid managed care, commercial plans, and third-party administrator services. Whether it’s strategic planning, compliance with regulations, financial and operational turnaround, product design, or data analytics, we have a consulting team with multidisciplinary payer expertise ready to support your organization.

ECG payer experts are trusted advisors to:Service Expertise
  • National insurance carriers.
  • Compliance and audits
  • Regional health plans (e.g., Blue Cross Blue Shield plans).
  • Payer analytics
  • Provider-owned health plans.
  • Financial turnaround
  • Third-party administrators (TPAs).
  • Health plan compliance
  • Management service organizations (MSOs).
  • Value-based care
  • Other risk-bearing entities (e.g., independent physician associations).
  • Health plan strategy
  • Pharmacy benefit managers (PBMs).
  • Medicaid consulting
  • Dental and vision plans.
  • Medicare Star Ratings

Product Expertise
  • Network alignment models
  • Medicare Advantage
  • Operations improvement
  • Managed Medicaid
  • Process optimization
  • Fully and self-insured commercial products
  • Product design
  • Workers’ compensation
  • Payer strategy
  • CMS Program Audits

Health Plan Consulting

ECG Experts


Medicare Advantage Stars Strategy Must Be a Top Priority for Health Plans

In the ever-changing and rapidly expanding Medicare Advantage (MA) landscape, plans must develop new strategies to improve their Stars program performance.


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