Experience
In the past decade the government health programs market has seen remarkable change. We have evolved from Medicare + Choice to Medicare Advantage and Part D. The program has added millions of new members. And today, change is more volatile than at any time in the past decade. It is the extensive experience that TMG brings to this market that results in value to its clients.
With over 10 years in the business of providing Business Process Outsourcing (BPO) to Health Plans with government health products, we have helped over 50 Health Plans successfully enter this challenging market. We currently support over 2.7 million members across our Medicare Advantage, Part D and Medicaid clients and serve members in all 50 states. Our clients range from large, multi-state or national plans with hundreds of thousands of members to small, regional plans with less than 2,000 members. We serve 14 Blue Cross Blue Shield plans including for-profits and not-for-profits. All of which adds to a broad understanding of the critical success factors needed to survive and thrive in this challenging marketplace.
The success of TMG Health is due to our singular focus and dedication to the government health programs market. We are the largest BPO provider dedicated to this market and it gives us a unique perspective on the requirements, challenges and trends facing our Health Plan clients. We manage a broad spectrum of Medicare Advantage products for our clients including HMO, PPO, PFFS, SNP and Part D. We serve clients offering Medicaid Managed Care and Med Supp products.
Another component of our success is based on our commitment to compliance. Our philosophy is to act like a Health Plan with the related requirements of staffing a compliance department, a corporate compliance officer, developing and following a corporate compliance plan and code of conduct. With the breadth of clients we manage, we have unique national perspective and understanding of CMS compliance requirements including both Regional Office and Central Office components.
Our experience also means we understand the value of developing and operating under a uniform set of Best Practices. TMG Health is audited annually to ensure compliance with SAS 70 Level 2 requirements. Our systems and processes have been stress tested over the years, including the many challenges associated with launching PDP products in 2006, and have been proven to be cost-effective, accurate, reliable and scalable. Our clients depend on TMG Health’s ability to quickly react to market or regulatory changes, thereby insulating them from both cost and risk.
Over the past 10 years we have developed a proven and fully vetted conversion methodology assisting Health Plans to migrate from internal systems and operations or from other outsourcing vendors. Our implementation and conversion processes are managed by an experienced Project Management Officer using the experience of TMG’s best practices and the Project Management Institute (PMI) Body of Knowledge standards. We offer product specific implementation plans that are built on experience but fully customized to the unique requirements of each client’s situation. We review lessons learned from each implementation or conversion and build this into a continuous improvement process.
The government health programs market has changed over the past 10 years and the rate of change is only expected to increase in the next few years. TMG Health has the experience to help Health Plans weather these changes. Our experience and dedication to this marketplace means our clients will remain compliant and competitive in an increasingly challenging industry.