Healthcare Providers

Program Evaluation

Along with program strategy and design, program evaluation is a critical component when planning health care program change.  States, other payers, plans and providers must be able to account for fiscal and policy decisions to justify expenditures for their programs, often answering to the Federal government, state legislatures, taxpayers and consumers.  Program evaluations provide the necessary analysis to support and steer these decisions.  The continual need to monitor on-going operations and performance is key to staying on top of the health of an entity's unique programs. 

Navigant is able to assist our clients with their program evaluation requirements.  Our approach establishes a framework for the evaluation that is inclusive of a program’s strategy and design to ensure that we are looking at the entire picture.  We understand how important it is to have the answers and understanding of whether a program is meeting expectations and where improvements can be made.  Results of evaluations can vary from complex statistical analysis to findings from surveys of consumers, but the information must be reliable and answer the questions about the program’s health. 

Evaluation services we offer our clients include:

  • Waiver or structural
  • Program performance
  • Eligibility
  • Provider reimbursement, including hospital, physician, long term care and other provider types
  • Vendor procurement and contracting
  • Stakeholder survey design and implementation
  • Focus group facilitation
  • Advisory board facilitation

For example, we have acted as the independent evaluator for several states’ Medicaid waiver programs, including 1915(c) Home- and Community-Based Services programs.  Other examples of relevant experience include evaluating state hospital rates and reimbursement methodologies to examine cost coverage and the need to rebase rates for Wyoming, Illinois and Washington; developing managed care monitoring tools and tracking systems in Pennsylvania; assessing contract agreements with third-party payers for the Veteran’s Administration; developing provider and consumer surveys to gather qualitative information about program performance in Texas, and monitoring the compliance of nursing facilities in California related to consumer cost, access and quality standards.

Navigant assists the Division of Quality Monitoring in Pennsylvania with the development of Consumer Guides and HealthChoices Trending Reports that use Health Plan Employer Data and Information Sets, Consumer Assessment of Health Plans and specific Pennsylvania performance measures to profile the performance of managed care organizations for Medicaid consumers.

Read our insights on the healthcare industry

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