Our healthcare system is changing rapidly, characterized by the emergence of new delivery system models, transformative payment methods and evolving provider entities that integrate care delivery and population management in new ways. Medicaid agencies, in turn, face new opportunities and pressures. Thus, Medicaid leaders must carefully consider:
- Which reforms are possible in their state
- What are the implications of pursuing various reforms in that state?
- What steps must the agency take to successfully implement those reforms?
Navigant helps Medicaid agencies answer these challenging questions.
Like our healthcare system, the list of reform options available to Medicaid agencies is evolving rapidly. Navigant can help Medicaid agencies address the reforms below, among others.
Primary Care Medical Homes (PCMHs) and Accountable Care Organizations (ACOs)
PCMHs and ACOs strive to provide integrated, coordinated approach to healthcare delivery that treats the person and not the disease. These models offer Medicaid agencies an opportunity to delegate increased responsibility to health systems and physician groups, among other providers, in either fee-for-service delivery systems or within capitated delivery systems.
Bundled Payments and Payment Transformation
Effectively managing healthcare cost increases requires addressing challenges inherent in the entire healthcare system relative to the delivery of the right care, in the right amount, at the right time. Traditional payment models encourage volume over value, with little financial reward for improving outcomes or delivering preventative care. Navigant is leading the way nationally in meeting these challenges. Our consultants are actively providing payment transformation services as policymakers are taking a renewed look at payment strategies to determine how to slow cost increases, incent providers to deliver more efficient and effective care to the growing number of beneficiaries, actuate clinical change and avoid unnecessary and redundant costs.
Medicaid Health Plans and Marketplace QHPs
Medicaid Managed Services
While some states are pursuing innovative approaches –like premium assistance – to cover expansion populations, others are moving ahead with straightforward expansions of their existing Medicaid programs. Regardless of the approach to expansion, Medicaid agencies are responsible for the expansion population and must demonstrate that they are meeting Federal requirements. Navigant helps with all the full spectrum of tasks Medicaid agencies perform as they pursue expansions – from program design, to development of implementation plans, to assessment of provider network capacity.
Waiver Program Design, Development and Implementation
Medicaid agencies have more flexibility than ever to implement reforms and to access enhanced Federal funds to support these reforms. But to take advantage of these flexibilities and financing, they must obtain Federal authorities, they must design viable reforms that meet Federal requirements and are suited to the needs and features of their state, and they must successfully execute. Navigant helps with all phases of this process, from preparing, for example, 1115 Research and Demonstration or grant applications, to assisting with procurements and to guiding agencies through all aspects of program implementation.
Pay for Performance (P4P)
Nearly half of the nation’s Medicaid agencies have implemented some type of pay for performance program, as have many other payers. As P4P programs become more common, Medicaid agencies will face increasing pressure to demonstrate the return on investment achieved through those programs – and, ultimately, will face. Navigant helps clients in the design and implementation of new P4P programs and the evaluation of existing P4P programs and development of more sophisticated P4P programs.
Value Based Purchasing (VBP)
While many organizations have implemented discrete VBP components like pay-for-performance, Navigant’s approach to VBP is more holistic and thorough – to increase the potential of achieving the desired outcomes. In short, it aligns all the tools and resources at a program’s disposal so that the Medicaid agency can get more “bang for the buck” out of those tools and resources.