Plan FocusSM

Plan Focus℠ is a mindset and a strategic commitment. As the name suggests, we focus on health plans. In fact, we turn down work from healthcare providers when it would be adverse to health plans.

A National Practice

We serve dozens of health plans, including national, regional, and local carriers. Our clients range in geographic scope from Hawaii, across the continental U.S. from the Pacific Northwest to New England and Florida and including Puerto Rico.

Our clients provide products and services ranging from health insurance, Medicare and Medicaid health plans, pharmaceuticals, and healthcare information technology.

  • Local, statewide, regional, and national insurers
  • Service providers for government health plans, such as vision and mental health benefits managers or pharmacy benefits managers (PBMs)
  • Global pharmaceutical companies
  • Investors evaluating health care opportunities

In addition to partnering with in-house counsel and compliance teams, we work closely with senior leadership, management, and front line-level personnel in Sales and Marketing, Procurement, Appeals, Utilization Management, Customer Service, Claims, and Information Systems.

Supporting Government and Commercial Plans and their Service Providers

We have worked closely with Medicare Part D Prescription Drug Plans since the program’s inception and have watched the regulatory and sub-regulatory requirements grow in complexity for Medicare Part C (Medicare Advantage) and Medicare Part D.

We counsel Medicaid Managed Care plans day-to-day legal issues, regulatory intricacies, and compliance matters. We have extensive experience helping health plans work within the laws and regulations governing Medicare Supplement or Medigap plans. Deeply familiar with the risks plans face, we are prepared to fight for our clients in all manner of disputes, including provider fee disputes, ACA litigation, and anti-fraud litigation.

We are also a great resource for service providers to health plans, such as vision, dental, and mental health benefits managers as well as pharmacy benefits managers (PBMs).

Industry Acumen

We devote a lot of time keeping up with legal and regulatory developments that affect health plans. As a result, we toggle easily between the granular level of regulations and agency guidance and the broader context of policy priorities and industry trends.

In other words, we know your industry like it is our own. We understand your business challenges and the regulatory environment, and know how to protect your interests, whether it’s in a deal negotiation, litigation, or a regulatory matter.

When you work with us, we become part of your legal team, deepening the bench and expanding your knowledge base. We are happy to work ourselves out of a job by training and equipping your in-house attorneys to handle as much of your plan’s regulatory work as possible. We want your business to succeed.

We Speak Health Plan

Clear communication forms the foundation of a great partnership. When we talk with any group in your organization, we make the complex comprehensible. In addition to building strong relationships with in-house counsel and compliance officers, we work well with senior leadership, management and front line-level personnel in Sales and Marketing, Procurement, Appeals, Utilization Management, Customer Service, Claims, and Information Systems. One of the greatest compliments we’ve received followed a training session on a highly complex issue: “You don’t speak government-ese!”

That’s correct. We speak Health Plan.

We understand you have budget constraints. Ask us about practical options, like packages of services, blocks of hours and fixed-fee arrangements.

Who We Serve

Medicare Advantage and Part D Prescription Drug Plans
Medicaid Managed Care Plans
Medicare Supplement or Medigap Plans
Service Providers to Government Health Plans