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Medicaid managed care: Managing costs, utilization, and quality

Our managed care services team provides a variety of services to help state Medicaid agencies improve their delivery of appropriate, medically necessary, and quality healthcare to their beneficiaries, including oversight and program management of health plans contracted with their state. Our independent and objective managed care services help Medicaid agencies reduce unnecessary healthcare costs, improve program outcomes, quality, and oversight, with the common goal of enhancing the experience of Medicaid beneficiaries.

Our team works on a variety of different managed care initiatives. We provide key insights to Medicaid agencies seeking opportunities to improve their delivery of services, expand and manage provider networks, and mature provider payment models. We can help you oversee benefits and services through contracted arrangements with Managed Care Organizations (MCOs). We offer guidance on:

  • Managed care contracting—Deliver Medicaid program healthcare services to beneficiaries, reduce Medicaid program costs, and better manage utilization of health services. 
  • Program enhancements—Guide innovative program enhancements, large-scale implementations, systems updates, and MCO compliance efforts to reduce programmatic costs and meet regulatory expectations.
  • Integrated care solutions—Improve care for populations with chronic conditions, align payment incentives with performance goals, and build in accountability for high quality care.
  • Utilization and reimbursement strategies—Rethink the control of program costs, find program flexibilities to expand coverage such as telehealth, and make operational changes to support growing member populations.
  • Provider networks and payment models—Assess and plan for the development of provider networks and payment models.

Our services include:

  • Compliance consulting—Deliver expertise with federal, ACA, COVID-19, and HIPAA compliance and Mental Health Parity and Addiction Equity Act (MHPAEA) requirements to support mental health parity compliance.
  • Organizational consulting—Optimize your operation with business process improvement, change management, and organization development services.
  • Project management and planning—Strengthen your agency in a variety of capacities with project management, RFP and requirements development, quality assurance, strategic planning, and contract management.
  • Readiness review assistance—Help ensure operational readiness for your managed care program through desk-level review assessments and systems review demonstrations.
  • Managed care policy analysis—Gain insight on policy and legislation analysis and documentation development.
  • Population expansion guidance—Understand your options and considerations for carve-in management and implementation.

With ever-changing and newly enacted regulations in the healthcare industry, BerryDunn’s team helps Medicaid agencies develop innovative solutions for complex problems. Contact our MCO consulting team to learn more.

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