About Us

Targeting the High-Risk: A Consulting Group with a Mission

Frail and chronically-ill Medicare and Medicaid beneficiaries represent US health care's highest-cost and fastest-growing service group. The Center for Medicare and Medicaid Services reported in 2012 that dual-eligible beneficiaries were more likely to have multiple chronic conditions (Chartbook on Chronic Conditions Among Medicare Beneficiaries*). CMS found just 14% of beneficiaries with 6 or more chronic conditions accounted for 55% of total Medicare spending on hospitalizations.

Fragmented acute and long-term care methods and multiple and conflicting oversight structures create beneficiary confusion, establish unnecessaryaccess barriers, lead to preventable medical complications and needlessly raise costs. Consumer satisfaction and meaningful quality improvement and cost control are dependent upon eliminating "system failure" in serving high-risk beneficiaries. Health care delivery, financing and administration must be realigned in relation to a host of interdependent care needs to simplify access, empower patients and family caregivers, and ensure efficient and effective provision of high-quality services.

The National Health Policy Group (NHPG) was founded to change these unacceptable conditions and to improve payment, policy and oversight structures to better meet the needs and improve the situation facing our most vulnerable, frailest and special needs citizens.

*https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/downloads/2012chartbook.pdf

Our Vision:

  • SNPs will become the vehicle of choice for serving frail, disabled, and other Medicare and Medicaid beneficiaries with complex care needs.
  • Clinical interventions will be designed to serve the whole person and recognize the volatile, co-morbid, interdependence and ongoing nature of complex chronic conditions as a persons care needs evolve over time and across care settings.
  • Medicare and Medicaid payment and oversight will recognize the dynamic, multidimensional, collaborative and continuous nature of care for frail elders, adults with disabilities and other persons with severe or disabling chronic conditions.
  • SNPs will demonstrate better total cost and quality performance in serving high-risk groups than for other mainstream managed care and fee-for-service options.

We Believe:

  • Fee-for-service financing and policy impedes the ability of plans and providers to effectively address the multidimensional, ongoing and interrelated care needs of frail elders, adults with disabilities and other persons with complex chronic conditions.
  • Pre-paid, integrated, specialized care is the preferred approach to serving high-risk beneficiaries with the potential for better quality, cost and satisfaction performance.
  • The SNP provisions in the Medicare Modernization Act of 2003 provide a platform to develop new and improved methods of care management and delivery.
  • Further changes in policy, financing and practice are needed to improve total quality and cost outcomes and ensure for the long-term viability of Special Needs Plans.

Changing Policy and Practices to Help

NHPG is a national health policy and consulting group established to help improve policy and practice in care of high-risk beneficiaries including the dually eligible, frail elders, adults with disabilities and others with serious chronic conditions. Clients include Medicare and Medicaid plans, providers, health systems, the public sector and national associations.

NHPG services include:

  • Strategic visioning and planning
  • Change-based leadership
  • Coalition development and management
  • Legislative and regulatory analysis
  • Public policy development and advocacy

Managing the SNP Alliance

In early 2003, NHPG founded and began management of the SNP Alliance, a coalition of leading plans and providers serving special needs beneficiaries. Our mission is to improve the long-term business viability of Special Needs Plans. SNP Alliance members are strongly committed to enhancing total cost and quality performance for high-risk populations.