Medicaid

Our Perspective

Medicaid is the single largest source of health insurance coverage in the United States and continues to expand. From 1990 to 2009, Medicaid enrollment nearly doubled. The preliminary reports for 2016 estimate that the number of Medicaid enrollees has grown to approximately 70.5 million, with California accounting for approximately 10.5 million members. Accommodating this growing population requires sufficient medical and financial resources, coordinated care, population health management, and enhanced reporting abilities. As the anticipated changes to the Affordable Care Act (ACA) emerge, payers and providers will need to respond quickly to deliver quality care to the growing population while managing organizational costs.

T2C has developed a comprehensive framework to structure an approach to overcome your Medicaid challenges and remain prepared for potential environment impacts.  We collaborate with our clients to provide the support you need at any phase to deliver the critical success factors for your organization.

T2C Medicaid Framework

Coordinated Care Coordinated Care/Managed Care Strategy IT Technology Development Outcomes and Reporting Analytics Claims Management Contracting and Financial Management Community Engagement and Communication

Coordinated Care/Managed Care Strategy

  • Align leadership and partners on goals, implementation strategies, operational infrastructure; organizational roles, and care delivery models
  • Design infrastructure, governance and oversight for hospitals, counties and sub-regions
  • Integrate behavioral healthcare and Population Health Management into care delivery systems

IT Technology Development

  • Collaborate with multiple vendors across the healthcare spectrum (i.e., population health, analytics, and/or revenue cycle)
  • Select new platforms and/or optimize current platforms to support organizational strategy, system integration and workflow integration
  • Identify platforms for sales/quoting, enrollment, billing, product definition, provider contracting, claims processing, encounter submissions, care management and customer service

Outcomes and Reporting Analytics

  • Implement analytical and business intelligence tools, measurement review and monitoring practices to enable ongoing process improvements and demonstrate improved outcomes and achievement of measures to qualify for payments.
  • Ensure a smooth launch for reporting capabilities related to new regulatory claims and encounter reporting for Medicaid line of business

Claims Management

  • Enhance and mature claims testing processes
  • Improve accuracy and forecasting of capitation payment reconciliation
  • Reduce costs and increase claims accuracy

Contracting and Financial Management

  • Develop bidding strategies
  • Manage capitation payment audits
  • Assess provider contracting and enhance claims processing infrastructure

Community Engagement and Communication

  • Coordinate and track community engagement and communication programs utilizing large-scale and complex project management expertise
  • Define strategies to transform relationships with the provider communities and enhance the quality of care delivered to members
  • Establish buy-in and alignment across stakeholders for new platforms, vendors and implementation plans

T2C has helped clients successfully address these important issues. Our senior level practitioners have domain knowledge of Medicaid and can help you develop the right solutions to meet your needs.

ARE YOU MANAGING COSTS WHILE OPTIMIZING QUALITY?

We can help. Partner with T2C today.