BluePeak Advisors, a division of Gallagher Benefit Services, Inc., was established in 2010 by a group of government healthcare professionals dedicated to solving the Medicare Part C and D Programs’ unique regulatory and operational challenges. Our consultants are senior level managed care professionals, experienced clinicians and former Centers for Medicare and Medicaid (CMS) regulators who have worked at health plans, pharmacy benefit managers (PBMs), and CMS. Our team has experience and expertise to service our clients in every aspect of Commercial and Medicare programs. BluePeak’s focus lies in PBM and Medicare Advantage (MA) and Medicare Advantage Prescription Drug Plan (MA-PD) health plan operations, Medicare compliance consulting, STAR rating improvements, CMS advocacy and support, pharmaceutical manufacturer marketing, and payer strategies for reimbursement. BluePeak also has expertise in operational and clinical program strategies, data analytics, and Medicaid managed care, Special Needs Plans (SNP), Program of All-Inclusive Care for the Elderly (PACE) Plan audit and compliance. BluePeak’s unparalleled operational and audit experience positions us to solve any issue and ensure operational success and audit readiness.
BluePeak is a leading national healthcare consultancy that focuses on government programs including Medicare Parts C and D, Medicaid, and Exchanges. We assist health plans, pharmacy benefit management (PBM) companies allied health companies and pharmaceutical manufacturers with regulatory, operational and compliance issues. BluePeak can analyze an organization’s processes and provide practical solutions, operational best practices and training to meet Medicare and other government program standards in all key areas.
Beginning in 2025, the prescription drug law, known as the Inflation Reduction Act, requires all Medicare prescription drug plans (Medicare Part D plans) — including both standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage — to offer enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy, otherwise known as the Medicare Prescription Payment Program or M3P.
BluePeak can support the implementation of M3P at every stage of the process including Enrollment, Marketing, Billing, Claims Processing, Planning for questions and complaints, and Termination.
BluePeak understands the specialty market of All-Inclusive Care for the Elderly (PACE) plans and the importance of delivering of health care services to participants enrolled in PACE Organization with remaining compliant with CMS regulatory requirements associated with access to services, drugs, and other protections. Since CMS has increased its focus on audits of PACE plans, we anticipate the growing regulatory scrutiny that some PACE plans are facing–scrutiny and even receiving sanctions and civil money penalties (CMPs) for non-compliance. PACE audits evaluate the delivery of health care services provided to participants enrolled in PACE Organizations. It is critical for plans to have compliant and effective procedures in place to improve the efficiency and effectiveness of the audit process.
BluePeak assists PACE Plans with Quality Review, PACE Audit Protocols, Part D regulatory guidance and PDE/DIR support, Audit Process and Case Review preparations.
One of the most important activities that you can perform to get ready for CMS audits is practice universe pulls and mock CMS audits. BluePeak can assist you with preparation of universes, training of staff to present during the CMS audits and provide subject matter expertise in each of the CMS audit areas. We employ former CMS auditors so that we can execute a mock audit just as CMS will perform the audit. The report will contain information that will allow you to understand exactly where the issues lie and will give you actionable tasks that will allow you to remediate BEFORE CMS identifies the issues.
BluePeak’s comprehensive Medicare Annual Enrollment Period (AEP) Support from pre-AEP, during and post AEP including:
BluePeak Advisors can provide health plans and pharmacy benefit managers assistance with Part C and D Medicare operations remediation and efficiencies.
BluePeak will prepare health plans and PBMs for CMS Program audits by performing mock CMS audits utilizing CMS protocols, reviewing operational area universes for compliance, supporting your teams during the actual CMS audits, assisting with writing corrective action plans and providing validation audits before CMS returns.
Medicare, the Exchanges and other government programs are evolving on a daily basis. BluePeak can provide health plans, Employer Group Waiver Plans (EGWPs) and PBMs strategic direction for product development and expansion both from a business growth perspective as well as from an internal support need.
BluePeak is a leading national healthcare consultancy that focuses on government programs including Medicare Parts C and D, Medicaid, and Exchanges. We assist health plans, pharmacy benefit management (PBM) companies allied health companies and pharmaceutical manufacturers with regulatory, operational and compliance issues. BluePeak can analyze an organization’s processes and provide practical solutions, operational best practices and training to meet Medicare and other government program standards in all key areas.
The largest segment of our business is focused on health plans and assisting you with compliance, operations and interim staffing solutions. We are a leading Independent Validation Audit (IVA) vendor and have conducted over 150 mock Centers for Medicare and Medicaid Services (CMS) program audits and onsite support projects for clients undergoing actual CMS program audits.
A large segment of our business is focused on pharmacy benefit management (PBM) companies and assisting you with compliance, operations and interim staffing solutions. We have extensive experience in the PBM world, both on the clinical and operational side, with many operations experts and both founders of BluePeak being from the PBM industry.
BluePeak’s value to pharma stems from our extensive knowledge of the health plan, PBM and employer client marketplaces since we deal with them daily. We have in-depth experience with CMS policy and operational issues, and experience with many of the current PDPs and MAPDs.
BluePeak supports allied health companies in their efforts to provide compliant and effective products and services to health plans and Pharmacy Benefit Managers (PBMs). Applying insight gained from working with these industries, we provide clinical and regulatory subject matter expertise.
BluePeak is familiar with the nuances between states and their administration of the Medicaid program. We are able to provide many of our Medicare services, such as mock audit and audit support, marketing material review, operational assessments, and others, to our Medicaid clients.
BluePeak understands the importance of formulary management in driving clinical and financial outcomes. Our multi-disciplinary team can design and manage formulary solutions that align with your organization’s unique goals.
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