Healthcare Providers

Program Implementation and Operations

States, the federal government, plans and providers are constantly required to implement programmatic changes, as well as modify program operations to address reform, improve programs, and comply with regulatory change.  These challenges present both opportunities and barriers when implementing change into operations.

Our Navigant team helps our clients implement and improve their operations, as well as help them monitor their programs, networks and contractors.  We can assist throughout the entire life cycle of program implementation, from the initial drafting of rules, regulations, State Plan Amendments and Requests for Proposals, to providing support throughout the procurement process, including contractor readiness reviews, to developing and providing training and communications to affected personnel and stakeholders as a new program is brought online.  After implementation is complete, we provide support to maintain and enhance ongoing program operations, including conducting performance audits, contract compliance reviews and program evaluation and monitoring.

Our consultants come from all sectors of the healthcare industry including health plans, hospital systems, physician organization and state agencies.  This allows us to arrange the right team, with the right expertise to address our client’s implementation and operational needs.

Some of the services we offer our clients include:

  • Drafting of regulation packages and state plan amendments
  • Waiver application development and implementation
  • Assistance with Federal/State program change negotiation
  • Procurement design and support
  • Payer, provider or contractor readiness reviews
  • Contract and program monitoring
  • Operations and performance reviews
  • Monitoring of program access, quality and cost components

We have assisted state Medicaid and SCHIP agencies in every phase of designing, developing, implementing, monitoring and supporting both managed care and innovative fee-for-service programs.  We have also assisted health plans in developing and operating programs to serve the Medicaid and SCHIP populations, as well as assess operations to evaluate their compliance with state and federal regulations.  After designing new Medicaid program benefits, we have represented states such as California in negotiations with the federal government and other stakeholders to approve new benefits, payment rates, utilization controls, financing mechanisms and future program updates.

Click here to read our insights on the healthcare industry.

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