Medicaid

Our support to state healthcare agencies extends across program redesign, waiver development, managed-care contracting and performance management, program governance, and value assurance on integrated eligibility systems (IESs) and Medicaid-management information systems (MMISs). Our work includes statewide, value-based payment-model implementation; Medicaid-expansion planning; managed-care transition; and business-process redesign related to IT transitions.

We help set and achieve ambitious agendas across growth, operational excellence, and innovation. . Our work spans national and local organizations, provider-led entities, and organizations focused on addressing special needs populations (e.g., behavioral health, long term service and supports, and dual eligible individuals). We deploy analytics to support MCOs to identify the areas where they can best impact the quality and efficiency of care; expanding member access to high-value care; and enhancing member experience of care.

We help health systems that serve Medicaid beneficiaries in transforming their care-delivery and financial-management models to provide optimal care.

We support investors in creating value in the Medicaid ecosystem in a way that fits with their portfolio goals. Our work includes market scans prior to due diligence, asset due diligence, valuation, negotiation, and value capture after due diligence.

We worked with a state Medicaid program to improve quality and health outcomes. By deploying claims analytics, referencing our library of clinical concepts, and mobilizing a team of data scientists, clinicians, operations and IT practitioners, and medical-policy experts, we conducted a diagnostic to pinpoint efficiency-improvement opportunities. Areas we explored included fee for service, managed-care delivery, acute care, long-term care, behavioral health, and Medicaid financing. The long-term-improvement potential we identified ranged from 5 to 10 percent of total program expenditure.

We supported a state Medicaid program in applying for a State Innovation Model Test Award. We helped the client implement a statewide program for complementary population- and episode-based care-delivery and payment models, enabling the associated technology-infrastructure and solution design, and managing stakeholder relations, regulatory analysis, program management, and governance. An evaluation of the program’s impact identified cost-trend improvement of 1.9 percent for participating providers while achieving an annual quality improvement of 2.2 percent on priority measures over a three-year period.

We supported a multistate MCO looking to transform its operations by removing cross-functional silos and accelerating implementation of operational and clinical best practices across states. The program went beyond rapid saving opportunities to focus on deep systematic changes and the development of new capabilities for the organization. As a result, the MCO rapidly modernized its operations while generating savings equivalent to around 10 percent of the gross margin.

We supported a regional duals MCO to develop a strategy to enhance its growth and diversification, including exploring opportunities to expand its mission. This journey began with a strategic diagnostic which included an environmental landscape, capabilities assessment, and an evaluation of potential avenues in line with the organization’s mission and strengths. We then supported the organization on diversified business-building, claims-based population analytics, and medical cost transformation. The result of this work was a road map to grow the enterprise by 3-5x over five years.

We supported a multi-line health plan looking to enter Medicaid and identify opportunities to rapidly accelerate growth while protecting the core business and engage their stakeholder group. Through this work, we conducted a diligence and post-acquisition strategy including the integration of acquisitions with the core business, including developing an organic growth pipeline for Medicaid RFPs and a capability assessment of the investments required to scale in the space. The work resulted in the successful build and scale of the enterprise’s Medicaid business – supported by the capabilities required to sustain growth.