Government Agencies
States are facing enormous challenges today...
They find themselves in a marketplace that requires them to work more like private sector entities. To be creative and flexible. Yet they are committed to a different population, and are bound by regulations and roller coaster funding cycles, which make their efforts more difficult.
All across the nation, Medicaid is the number one budget consumer. ..the aging and uninsured population grows, and more low-income families and children need healthcare...
These days, most states are reporting shortfalls.
And while the American Recovery and Reinvestment Act offers some assistance, each state must ultimately find ways to control and manage its growth...
It seems overwhelming, but states are determined to modernize their programs to make them fit with today's realities.
They are looking to primary care models, and to managed care, to improve access and to create patient-centered systems.
And even though they must balance incredible budgetary demands, they still focus on quality, because they see quality as a way to reduce costs in the long term.
More and more states are interested in value for the dollar, with high- quality, outcome-based services and an eye toward preventing illness rather than just treating it. They are committed to new and innovative ways of providing healthcare to their most vulnerable populations...
Today, states stand poised to partner in strategic ways in national health care reform. And they are calling on AS&A to help them succeed.
Take a look at some of our clients' stories...what we did working with them, we can with you.
Missouri
THE OVERVIEW
In the mid-1990's Missouri approached Alicia Smith for assistance in developing a coordinated care program for the elderly and disabled. From this single project beginning, AS&A's relationship with the State of Missouri has grown and now we work with the state to provide ongoing strategic, technical, and operational assistance in all aspects of the Missouri Medicaid and SCHIP programs.
THE ACTION
*We worked with the state to develop a health insurance program for low-income uninsured Missourians that incorporates both a DRA state plan amendment approach and a section 1115 waiver approach.
*We assisted the state in the preparation of the: DRA State Plan Amendment, section 1115 waiver proposal, model managed care contract, and Request for Proposal for insurance carriers.
*We teamed up with staff to analyze programs and funding streams for children receiving mental health services.
* We analyzed policy alternatives to address children transferred to state custody to receive certain behavioral health services from its Department of Mental Health Services.
*We worked with staff to develop and analyze a federal funding optimization plan for a teaching hospital and hospital-owned HMO.
* We worked with Mental Health staff to develop a New Freedom Initiative grant proposal: comprehensive system of care for children (C-TAC).
*We provided strategic planning and technical assistance for Missouri's original 1115 waiver.
*We assisted with the preparation and development of a comprehensive procurement for managed care organizations, designed to promote quality, accountability and access for Missouri’s HealthNet Program and its recipients.
*We continue to conduct annual evaluations of Missouri's section 1115 waiver.
THE OUTCOME
In broadening and continuing its relationship with AS&A, the State of Missouri takes advantage of our wide-ranging experience and up-to-date expertise to successfully achieve its program goals.
AS&A subcontracts with Covington & Burling LLP on this project.
Florida
THE OVERVIEW
When the State of Florida decided to tackle Medicaid Reform, program staff realized that it meant fundamentally changing the Medicaid program. It would empower recipients to take more control of their health care; enhance consumer choice; offer more health plan options; include targeted benefit packages: provide a strong choice counseling component, and offer options to earn rewards for healthy behaviors. In order to achieve this innovative, yet monumental vision, the state knew it would have to rely on a firm with solid experience and expertise in all aspects of the design, development and implementation of it's ambitious Medicaid Reform project.
THE ACTION
*We helped write the 1115 waiver for Medicaid reform.
*We worked closely with staff to design and develop the choice counseling program.
*We partnered with Medicaid staff to develop the health plan and choice counseling contracts, procurement documents and evaluation tools.
*We assisted with pre-implementation tasks and implementation planning, in the original pilot areas and the second phase.
*We assisted in briefings for decision makers and facilitated public meetings and focus groups for stakeholders.
*We created monitoring tools as well as continuous quality improvement programs.
*We are actively involved in monitoring Call Center operations to improve responsiveness, quality and communication between the state’s vendor and Medicaid members.
*We continue to partner with Florida to develop monitoring strategies that will enhance the accountability of the state’s managed care organizations.
*We are assisting the state in conducting a series of workshops for its managed care organizations that not only improve communications, but also instruct the organizations on how to address issues identified by the agency and take corrective action.
THE OUTCOME
The State of Florida has successfully implemented Medicaid reform in a very short time and continues to engage AS&A's services to monitor the program for continuous quality improvement. As Florida expands its reform program AS&A is actively assisting them prepare for the impact of this expansion.
AS&A and Florida staff has worked together so well, that the state asked us to help design and develop a new integrated health care system for the elderly and disabled. We assisted in the development of a model contract for health plans, including the innovative element of participant direction within a managed care delivery structure. We also assisted in the facilitation of public meetings and focus groups across the state to obtain public input into the program design.
AS&A subcontracts with Mercer Government Human Resources Consulting on this project.
Hawaii
THE OVERVIEW
As early as the mid-1990's Hawaii was on the cutting edge of health care programs. The state wanted to implement an innovative program called Quest, that would enable it to use managed care to provide insurance coverage to its entire state population. But the state needed help from health care experts in order to succeed in its ambitious effort.
THE ACTION
*We provided all aspects of technical assistance to implement the transition to a managed care plan delivery system.
*We managed all aspects of the procurement process to solicit health plans for the QUEST program.
*We provided strategic advice, policy analysis, and document drafting, to help the state re-design its 1115 waiver renewal and program plan.
*We negotiated with state and federal officials to optimize federal funding for a state hospital through supplemental payments.
*We provided consultative support for the development of a Medicaid drug purchasing pool.
*We developed issue and policy papers that provide decision-makers the ability to analyze the transition of the state's Medicaid managed care programs to include Medicaid-eligible Aged, Blind and Disabled citizens.
*We assisted in the development of the state's 1115 Waiver renewal application to transition the Aged, Blind and Disabled citizens into managed care.
*We developed the RFP to procure managed care organizations for the state’s Aged, Blind and Disabled population.
*We helped conduct a Readiness Review of those managed care organizations.
*We continue to assist the state in monitoring the implementation of its managed care for the Aged, Blind and Disabled population.
*We are helping the state to develop monitoring strategies, designed to build on its partnership with managed care organizations, to improve and enhance its service delivery to Quest members.
THE OUTCOME
Due to the success the state has achieved in providing health care services for its clients, Hawaii continues to call on AS&A for all aspects of technical advice, consultation and action.
After more than a decade of top quality work, AS&A is proud to be a part of the state's success. Hawaii is ranked the number one state in the union for providing health care services to its people.
AS&A subcontracts with Covington & Burling LLP on this project.
Georgia
THE OVERVIEW
The state decided to take on the enormous job of transitioning its Medicaid Program from fee-for-service to a fully capitated, managed care program for TANF, SCHIP and other non-ABD, non-special needs populations. Along with this, they needed to identify the information and systems functionality required to facilitate the program management However, it became clear to them that in order to be successful, they would need to call on a firm with a national grasp of the issues involved in implementing such plans as well as an excellent reputation for turning a state's vision into reality.
THE ACTION
*We helped with the negotiation with CMS for approval to implement the program.
*We worked with them, "soup to nuts," in every aspect, on every phase of developing, designing, and evaluating the effort to implement a transition to managed care.
*We developed implementation plans, and drafted contracts and procurements.
*We worked together to develop information system architecture.
*We designed and evaluated a CPE-based hospital reimbursement program under Medicaid.
*We developed short-term and long-term models for assessing different assumptions about enrollment and service utilization.
THE OUTCOME
In order for the transition to managed care to be successful, the Department had to go through a massive reorganization. AS&A walked side-by-side with them through this process so that the Department could make better use of existing resources and change its dynamics to meet the new realities of the Medicaid program
The reorganization was achieved.
Today the Department monitors and implements its programs effectively and efficiently. And the Georgia Healthy Families Program is, by all accounts, a success.
Tennessee
THE OVERVIEW
In the early 1990s Tennessee was an early innovator as one of the first states to receive permission from the federal government to require the majority of its Medicaid beneficiaries to enroll in managed care. Recently, when Tennessee was looking for assistance in reforming its Medicaid managed care program to reflect current best practices, they once again turned to AS&A. Impressed with the quality of our previous track record in their state, Tennessee decided to benefit from our national perspective and years of experience.
THE ACTION
*We drafted a request for information (RFI) to gauge health plan interest in bidding and soliciting feedback on a reformed managed care model. This plan called for returning to full risk, as well as integrating the delivery of physical health and behavioral health services.
*We worked with the state to develop a request for proposals (RFP) to procure health plans to serve the Middle region of Tennessee using the reformed managed care model.
*We assisted the state in significantly revising the existing managed care contract to reflect the requirements of the reformed managed care model.
*We drafted responses to bidders’ questions regarding the RFP.
*We developed an evaluation guide to assist in the evaluation of proposals.
*We assisted the state in conducting a comprehensive readiness review of the health plans, including both document review and onsite visits.
*We assisted with implementation of the reformed managed care model in the Middle region.
*We assisted the state with a procurement for the East and West regions of Tennessee, incorporating lessons learned from implementation of the reformed managed care model in Middle. This included developing the RFP, revising the managed care contract, drafting responses to bidders’ questions, and developing an evaluation guide to assist in the evaluation of the proposals.
*We assisted the state in conducting a comprehensive readiness review of the health plans for the East and West regions, including both document review and onsite visits.
*We worked with Tennessee to develop enhanced standards for delivery of non-emergency medical transportation (NEMT), including vehicle, driver, pick-up and delivery, and call center standards.
*We assisted Tennessee in developing an enhanced cost avoidance and recovery program in a managed care environment.
THE OUTCOME
Tennessee is the first state for a price-point based insurance product for the low-income uninsured. Ultimately the winning insurer bid two different packages around that price point, fully at risk.
AS&A is proud of the fact that we were asked to take a piece of legislation that had very little guidance and help the state create a program that that has absolutely no federal dollars involved; that offers employers an affordable health insurance package to employees, with the average person paying $50/month.
Time Magazine has cited Cover Tennessee as an example of state initiative and action to address issues "where the feds won't go".
To date, 5000 Tennesseans now have affordable health insurance under this visionary, first-of-its-kind program.
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