A large, multi-state, east coast managed care plan was directed by senior management to create a business plan to prepare for healthcare reform and expand services to include publicly funded healthcare clients. Based on a referral from a western affiliate, the plan engaged our team of experts to lead a three-year, multi-stage project that included:

  • Thought leadership on federal and state approaches to managed care and the impact of healthcare reform;
  • Medicaid market analysis, including political, budgetary, competitor and regulatory analysis;
  • Comprehensive internal gap analysis, including mapping major internal operational capabilities against regulatory/procurement requirements; and
  • Market entry recommendations for a senior management debriefing.

The client had an acute need for reliable data and strong thought leadership because the decision to enter the Medicaid/CHIP market would be highly visible, political and require extensive internal planning resources to accomplish.

The Solution

Our team included experts in health plan management, Medicaid policy and operations, healthcare reform and health insurance exchanges. A full project plan was developed to guide the effort, which engaged an internal management team and members of senior staff to support and develop a comprehensive assessment of organizational and operational systems throughout the health plan.

Our team provided the perspective and quantitative information to enable senior management to make critical decisions that resolved sensitive issues around the successful implementation of the health plan.

The Value Proposition for the Client

The health plan chose one state in which to pilot the Medicaid/CHIP market, established a timeline, and convened an internal team to begin the implementation process. The commitment of resources and creation of a target implementation date supported the community benefit requirements for a nonprofit health plan and met corporate expectations for the Medicaid/CHIP engagement.