We have the deep understanding and expertise with vulnerable and complex populations needed to support your organization with a broad range of solutions. Our solutions incorporate best practices for care management and member engagement, including the integration of social determinants of health (SDoH), and mental health services. We support organizations in understanding and designing solutions to meet their unique needs, and designing new programs and approaches to improve outcomes.
Health Plan Care Management Assessment: We’ve completed reviews and assessments of care management models for both integrated and carve-out programs for individuals experiencing serious mental health (SMI and SPMI) conditions. Reviews have included identifying opportunities for improvements and program expansion including the integration of social determinants of health (SDoH), telehealth and other remote delivery options (including remote medication-assisted therapy), expansion of peer programs and wraparound supports, and other MH best practices.
Integrated Health Home Design: We worked with a major national insurer to design one of the nation’s first health home programs. This work became a foundational element for our own proprietary model for the integration of medical and mental health. We have since expanded these concepts for application in several organizations.
Model of Care Design: We worked with a large national insurer to develop a comprehensive model of care framework and key elements, including social determinants of health (SDoH) to support the expansion of their programs to several new states. The model includes all elements from population assessment and stratification, to benefit and delivery design, and methods for engagement and care management. The framework has been used as a template for program design, bid development and implementation in several new markets.
Medicaid Bid Development and Support: We’ve provided proposal writing, proposal review, content research, and program definition services for numerous Medicaid bids. These have included both standalone mental health programs and behavioral health programs as part of broader Medicaid programs.
Individuals with Disabilities
Aged, Blind, and Disabled (ABD) Programs: We’ve supported several partners in the assessment of program expansion opportunities for ABD. Projects have included evaluation of population characteristics and requirements, assessment of program needs, and development of comprehensive models to serve the complex health and social needs of these individuals.
Dual Eligible Program Design: We worked with a major national insurer to develop a program model and identify unique requirements for implementation in several new markets. Model design focused primarily on care, delivery and outcomes management.
Disabled and Waiver Population Bid Support: We have supported several proposal development efforts for disabled and waiver populations. These include both child and adult waivers; physical disability; mental health and substance use; and intellectual disability (ID). We’ve developed new content and program design, and provided competitive assessments for existing offerings.
Rural Models of Care and Delivery: We’ve worked with several partners to develop strategies and programs to support delivery and management of care in rural and frontier communities. Solutions have included both models for care and delivery and innovative methods for engagement and outreach.
Rural Program Bid Support: We’ve bid and proposal support for several existing, new and expanded programs targeting rural and frontier populations. Support has included content strategy and development, as well as competitive assessment and identification of innovative program features.
Veteran’s Administration (VA) Transformation SME: As noted elsewhere, we served as the lead SME for initial phases of the VA’s recent transformation efforts. The project included deep dives into VA programs and veteran care and support needs.
Medicaid Strategies and Support: Much of our work over the decades has been focused on Medicaid populations. We’ve designed and helped implement strategies, program improvement initiatives, and turnarounds for local, regional and national health plans and provider organizations. We have broad-based and extensive experience in this area.
CMS COOP Sustainability and Viability Reviews: As part of early efforts to save the ACA COOP health plan program, we supported CMS by designing and overseeing the completion of sustainability and viability assessments for most of the plans in the program. Reviews included all aspects of health operations, member and financial management, and we’re used by CMS and senior administration leadership to make key policy decisions. We served as the lead subcontractor and project director for a major consulting firm in completing this work.
Exchange Health Plan Turnaround and Transaction Support: We worked directly with several of the surviving COOP plans to develop turnaround plans and creative funding solutions to offset the loss of federal funds in several areas. Support included negotiations with CMS, other agencies, and financial partners.
Contact Us If We Can Help
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