Consulting for Allied Health Organizations

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Compliance Program Implementation

BluePeak’s Compliance experts can build and help you implement a Compliance Program customized to your organization that meets CMS and other regulatory requirements. We will evaluate your organization’s structure and design and implement a comprehensive and effective Medicare Compliance Program with oversight plans, issue resolution, and corrective action plan processes.

Comprehensive Oversight and Monitoring Programs

Every effective Compliance Program has robust oversight and monitoring programs to identify areas of risk and deficiencies in its internal operations as well as those delegated externally to vendors. BluePeak’s subject matter experts can evaluate your organization’s structure and build a customized and comprehensive oversight program that includes a CMS-required risk assessment and monitoring and auditing plans.

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Vendor (FDR) and Internal Oversight and Monitoring Programs

One of the major reasons plans get into trouble is that they do not have an effective, robust, compliant internal and/or downstream vendor monitoring program. BluePeak can develop or assist you in developing a customized program that is CMS compliant, while able to be operationalized with limited time and human resources. CMS is turning their attention towards how well plans are overseeing and managing their vendors.

Health Care Policy Analysis and Application

BluePeak understands the burden that daily HPMS memos can place on plans. We monitor, analyze, and summarize key Medicare legislation, regulations, and other CMS-issued guidance. We can provide training on policy-related issues and develop practical, actionable steps so Medicare plan sponsors can proactively address policy-driven operational challenges.

Pharmaceutical Analytics and Services

BluePeak provides strategy and services specific to pharmaceutical manufacturers’ needs. We are uniquely qualified to provide industry expertise including knowledge in the health plan and employer client marketplace, in-depth experience with CMS policy, and focused training sessions on the complex pharmacy benefits for public and private insurance.

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PBM Audit

PBM audits are an integral part of a plan’s overall risk assessment strategy and are essential in ensuring that financial and contractual terms are being administered as intended. BluePeak can perform comprehensive or targeted PBM audits for all lines of business, including Financial, Formulary Administration, Benefit Design, Rebate Administration, and Medicare Audit Review.

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