With the passage of the Patient Protection and Affordable Care Act and the advent of healthcare reform, a large, urban Medicaid health plan sought guidance on the impact of these transformational changes, particularly the implementation of health insurance exchanges.

The Background

Senior management of the health plan, which serves more than 400,000 Medicaid and CHIP members in a large and growing urban environment, sought thought leadership and strategic planning to determine the plan’s organizational readiness to become a commercial health insurer. Through a competitive bidding process, the health plan selected our team of experts due to our combined expertise in commercial health insurance, Medicaid/CHIP managed care operations and policy, and our successful engagements with safety net providers.

The Solution

The team assembled for this project consisted of experts in Medicaid and commercial health plan management, Medicaid policy and operations, healthcare reform and health insurance exchanges. The engagement included:

  • Developing multiple scenarios in a post-reform environment;
  • Leading a SWOT analysis for each scenario;
  • Supporting leadership in conducting an internal GAP analysis to identify organizational infrastructure requirements;
  • Facilitating senior management retreats to refine strategic options;
  • Providing thought leadership on the private health insurance market;
  • Assessing the competitive landscape in the health insurance exchange; and
  • Developing an opportunity grid to guide decision making by the board of directors.

The Value Proposition for the Client

The board of directors, with all of the information and insight it required to make the best decision, determined to continue to focus on its core competencies and chose not to expand into commercial health insurance at that time.