As founder and partner of Pacific Health Consulting Group, Tim Reilly brings over 35 years of experience in managed care administration and consulting. Tim provides the health care industry with financial, product development, licensure, and rate negotiations with a focus on the safety net and Medi-Cal. He has represented 11 Medi-Cal Plans in rate negotiations with the CA DHCS, and in setting internal provider rates.
Tim has extensive experience in both the public and private sectors and is the industry leader in providing managed care development and consultation services for publicly funded programs.
He has been the CFO of several local public health plans in California, including mostly recently LA Care, the nation’s largest public Medicaid plan. He helped guide LA Care during a period that saw revenue grow from $1 billion to almost $7 billion, and expansion into the Exchange and the Duals demonstration programs. As CFO in the plans he been responsible for the Finance, Accounting, Investment, Claims, IT, Auditing, Financial Compliance, Regulatory Reporting, and Rate Setting & Actuarial Services.
As a principal in the development of all six County Organized Health Systems (COHSs) and four Local Initiatives Health Plans, Tim holds a valued and unique position among the local public Medi-Cal managed care health plans in California. He currently represents the plans in several rate and financial workgroups with the CA DHCS.
He also played a significant role in developing the Children’s Health Initiative (CHI) to provide health insurance to every child across dozens of California counties. Tim works with a number of clients to develop innovative Knox-Keene licensed products for the Medi-Cal/Medicare, County Indigent, In Home Supportive Services (IHSS), and Uninsured/Small Group markets.
Tim has also worked with the private sector providing Financial, Acquisition & Due Diligence, Premium and Rate development services for Medicaid and commercial products.
Tim holds a MA degree in Public and Social Affairs and a BA degree in Experimental Psychology from the University of California, Santa Barbara.