DMoller Associates has deep experience and expertise in helping organizations like yours succeed in Medicaid and other government programs. We’ve spent decades helping our partners develop business and growth strategies, diagnose opportunities for performance improvement, implement operational and financial turnarounds, design systems of care and innovative solutions, and supporting successful bids, and investment decisions.
Our partners have included a range of healthcare organizations from small, multi-clinic operations to national health plans. We can help you figure out whether it’s a good move for your organization to enter a market or line of business, whether you should consider an exit, or if there are specific actions you need to take turn your business around. We provide examples of our work below.
National Medicaid Market Entry Strategy: Working with another consulting firm, our principal consultant, Dorothy Moller, led a project to assess whether a large national multi-line insurer should enter the Medicaid market. The project resulted in a novel, low-risk strategy which served as the perfect launching pad for building this new business.
Regional Health Plan Public Program Services Strategy: We supported a regional Blue plan with a multi-year effort to assess opportunities to expand one of its service businesses into several new public program areas. The project resulted in an exit from an important, but unprofitable market, and building and launching new capabilities in several others.
Regional Clinics Public Programs Strategy: We supported a multi-site clinic operation in a mid-Atlantic state in developing and implementing a strategy to expand into new adjacent programs and services. The organization was able to implement a phased redesign and growth strategy after a number of years of declining revenues.
Regional Medicaid Health Plan Turnaround: We completed deep dives and assessments for a multi-plan regional insurer that was experiencing significant losses across its business units. We identified specific targeted changes and developed a detailed plan to guide implementation efforts. The turnaround effort was successful and both units are now profitable.
Mixed-Model Medicaid HMO Turnaround: We completed comprehensive assessments of all operational areas to identify opportunities for performance improvement. This included several owned clinics that had been underperforming and losing money for years. We developed detailed plans for targeted improvements and supported implementation efforts, resulting in the eventual sale of the plan to a major national health plan.
Small Health Plan Turnaround Plan: We completed comprehensive assessments of all operational areas for two separate Exchange health plans to reduce losses and improve viability. We were able to substantially improve performance for both although one was eventually shuttered due to its inability to raise funds needed to shore up its risk-based capital (RBC).
Veteran’s Administration (VA) Transformation: Working with another consulting firm, we served as the lead subject-matter expert (SME) for the initial phases of the VA’s most recent transformation and redesign project. Activities included developing a new organizational vision, designing a new approach for expanding care in local communities and supporting executive learning programs.
Care Management and System of Care
Integrated SMI Health Plan Model of Care: We completed a review and assessment of care management programs and features for one of the nation’s first integrated medical-behavioral health plans for individuals experiencing serious mental illness (SMI and SPMI). The effort included the identification of opportunities to improve member outcomes and reduce costs of care, as well as new program features to meet complex clinical needs. The work led to the development of an organization-wide framework to apply program concepts across other populations and contracts.
Rural Medicaid Model of Care: We developed a model of care design for the multi-regional expansion of Medicaid throughout rural communities in one of the largest states in the U.S. The program included identification of unique rural needs and development of flexible models for engagement and treatment including mobile, telehealth, pop-up clinics and other innovative approaches that became the framework for the company’s successful bid.
Aged, Blind, and Disabled (ABD) Model of Care: We developed one of the first operational and clinical models to support the expansion of a national general Medicaid health plan into this much more complex program area. Development included nationwide cross-organization collaboration and design of new programs and became a template for further expansions in the area.
Medicaid Proposal Review: We have completed several reviews of health plan request-for-proposal (RFP) responses prior to bid submittal. Our reviews have included evaluation of likely scoring, opportunities to improve results, and identification of competitive gaps.
Medicaid Bid Strategy: We have supported several health plans with their assessment and development of strategies for their Medicaid RFP responses. Support has included evaluation of resources and capabilities, identification of required key program elements, development of program approaches, and recommendations for discussions with policymakers.
Medicaid Bid Development: We provide ongoing support, including proposal writing for Medicaid proposals in a number of program areas, including general Medicaid, intellectual disability (ID) and physical disabilities, SMI, waiver programs, and special populations. Our support has included original content development, research for new program areas, and review and editing of content across most program requirements.
Medicaid Acquisition Due Diligence: We conducted strategic due diligence for a Medicaid health plan acquisition by a large northeastern commercial health plan. This included assessment of capabilities and infrastructure for both the acquired and the acquiring health plan to ensure organization compatibility. The acquisition was successful, with the new plan now being a major market player.
Medicaid Divestiture Strategic Support: We provided strategic deal support for a large southeastern integrated system that was divesting its health plan as part of a restructuring and growth program for its organization. Activities included an evaluation of strategic fit with bidders and assessment of deal elements. The plan was successfully divested to a major national health plan, providing much-needed capital for the system.
Exchange Health Plan Financing Strategy: We developed strategies to secure and gain approval for external financing for several of the ACA COOP health plans. Support included negotiations and deal structuring in collaboration with CMS to meet program legal and regulatory requirements. The efforts resulted in the plans securing required capital and gaining Federal government approval.
Contact Us If We Can Help
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