Medicaid Finance, Delivery, and Payment System Reform
Policy makers are seeking ways to transform the delivery, payment, and financing of healthcare to improve health outcomes, improve efficiency, and build sustainable programs. Governments are using the tools developed and honed by the private sector to accomplish this, including expanding capitated managed care, developing reimbursement strategies that reward quality, identifying additional federal dollars to invest in public healthcare programs, and using data analytics to target areas or populations for improvement.
Client Success Stories
- Working with state, provider, and stakeholder clients, the firm has helped generate over $7 billion in federal financial participation for state Medicaid programs without any payment being subject to a disallowance.
- Developed and implemented state Delivery System Reform Incentive Program (DSRIP) waivers, including the largest one ever approved for the state of Texas.
- Assisted clients to create, modernize, or expand physician UPL programs — enhanced Medicaid payments to physician practice plans — to bring in millions of additional federal funds.
- Developed and implemented strategic initiatives for large public safety net hospitals to secure additional supplemental funding for hospitals to treat Medicaid patients.
- Identified state share and obtained federal approval for additional federal Medicaid funds for large industrial state, bringing in an additional $30 million annually in new federal money.
- Working with a state and relevant stakeholders, generated approximately $500 million in new federal funds to help state transition and modernize its inpatient hospital reimbursement system.
- Provided Business Process Re-Engineering (BPR) services to a Medicaid program as it established a Medicaid Electronic Health Record (EHR) incentive payment program and planned for the implementation of its first MMIS.