Healthcare Providers

Payment Transformation

Government payers and health plans face dynamic and significant challenges in today’s healthcare environment:

  • State Medicaid agencies and other state healthcare purchasers are under particular scrutiny as healthcare costs continue to rise and the need for Medicaid-funded healthcare services for increasing eligible populations far exceeds available funding. 
  • Taxpayer tolerance for additional public program funding is limited and the state funding shortfall will widen with the federally mandated Medicaid expansion takes effect in 2014, even with the federal government taking on the majority of the costs for the newly eligible. 
  • Health plans face the same healthcare cost increases and deal with cost-shifting as providers seek higher reimbursement to make up for lower public program rates and care for the uninsured.

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:

  • Provide value-based purchasing solutions which incent providers to deliver more efficient and effective care to the growing number of beneficiaries, actuate clinical change and avoid unnecessary and redundant costs. 
  • Are at the forefront of payment system design, development and operations for both state and commercial clients, including major health plans, state Medicaid agencies, state employee accounts, workers compensation and automobile liability insurers.
  • Have significant experience with pay-for-performance models that focus on improving quality outcomes and avoiding unnecessary costs.


  • Payment Transformation


  • We have developed and implemented strategies for incentive payments using custom applications for payers, as well as the various third-party vendor products, such as 3M’s™ Potentially Preventable Readmission and Potentially Preventable Complication models.

Our payment transformation team has the resources and knowledge to manage the tremendous data demands and challenges of rate development projects. 

  • We have an in-depth knowledge of and access to a wide variety of data sources used in rate development, including: inflation factors, hospital wage data, Healthcare Cost Report Information System (HCRIS) data and several other sources.
  • Our Navigant information technology specialists are experienced in systems analysis, data needs assessment, data acquisition, data conversion and validation, database design and development, data reporting, application development and consulting, with an emphasis in healthcare matters.
  • Our consultants are able to support virtually any size information management challenge with a standard application resource toolkit including SQL Server, SAS, Microsoft Access, Microsoft Excel, PERL and Visual Basic, among others.

The Navigant Difference

Navigant distinguishes itself through our size and our direct technical and strategic program planning experience with numerous state Medicaid agencies and commercial payers and the many providers and health plans that deal with these agencies and payers.

We are an industry leader in the design, implementation and evaluation of provider payment solutions for commercial health plans, state governments and the Federal government. We are working with dozens of payers and providers nationally to assess, design and implement strategies to help them prepare for value-based reimbursement and manage the transition to a lower-unit reimbursement environment.

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