Medicaid Cost Containment Solutions

We are here to help Medicaid agencies successfully scale the cost containment summit.

Medicaid program success is dependent on managing the rising costs of caring for its growing member populations. Many state agencies are challenged with how to address these complex issues. Meeting cost containment challenges with the right technical tools can ease your climb.

Let’s work together to help you find solutions to your critical cost containment challenges:

  • Eligibility Determination. You need to evaluate state and federal data sets, and synthesize the information found to determine member eligibility. Combined with our proprietary data analysis tools, policy expertise, operational experience and understanding of all eligibility rules, we evaluate eligibility and claims, and deliver sound recommendations and determinations.
  • Third Party Liability & Coordination of Benefits. Medicaid programs can recover significant costs and save millions by pursuing payment from other entities for services to Medicaid recipients. We focus on ensuring that Medicaid is the payer of last resort.
  • Program Integrity. Fraud, waste and abuse affects your program’s bottom line and the clients that you serve. We have developed tools to identify noncompliance and erroneously paid claims.
  • Pharmacy Pipeline Impact Analysis. Assessing the potential clinical and economic impacts of specialty drugs and new medication is crucial to forecasting Medicaid program costs. We can analyze the drug pipeline, develop formulary recommendations, provide prior authorization operations, and consult on specialty pharmacy and value-based purchasing.
  • Managed Long-term Services & Supports. Medicaid programs and their managed care partners must target resources, contain costs, manage risk and improve outcomes throughout the LTSS delivery process lifecycle. Our team’s expertise includes clinical guideline development, member engagement, network development, and utilization management.
  • Policy Design & Implementation. Many Medicaid leaders are interested in seeking federal waivers to develop innovative approaches within their programs. We provide strategic consultation and support to states as they implement the innovative flexibility authorized through waivers to ACA provisions.
  • Evaluation & Data Science. State agencies and health care organizations must evaluate health care programs, analyze data and deliver actionable recommendations and strategies.  Our team employs methods including program logic models, statistical techniques, and stakeholder input to enhance the understanding of a program’s impact.

Our team has over two decades experience supporting the Medicaid health care ecosystem. We help states develop evidence-based clinical, operational and financial strategies for serving Medicaid’s most socially vulnerable and clinically at-risk populations.