A public hospital system required help to identify, develop, and participate in new supplemental payment programs to reduce the Medicaid funding gap that resulted from the dramatic increase in Medicaid volume after the expansion of Medicaid under the ACA.

The Collaboration

After an in-depth analysis, our Medicaid financing experts helped identify a value-based payment approach that integrated prior supplemental payments to be consistent with the requirements of the final CMS Managed Care Rule by linking payments to the utilization and delivery of services under Managed Care Plan (MCP) contracts. To ensure that the public hospital system would be included in the program, we worked with the hospital system to define strategy, analyze stakeholder input, and advise communication with state officials. Our work helped the hospital system take part in a program that rewards quality and efficient patient care with additional payments.

The Results

Our collaboration helped identify additional funds from a new pay-for-performance program. Payments under the program would be tied to the achievement of performance on a set of established quality measures for Medicaid managed care enrollees. The proposal that was submitted for delivery system and provider payment initiatives was approved by CMS. Our relationship with the hospital system is ongoing, and we continue to work with them on other engagements and opportunities.