Milliman offers state governments, health plans, and providers a broad perspective on Medicaid services, providing innovative solutions to help them better evaluate risk and manage costs.
With Medicaid, stakeholders must navigate the complicated
and highly-regulated system of requirements set forth by the Centers for
Medicare and Medicaid Services (CMS). They also face rising expectations on
cost containment and must deal with Medicaid expansion under the Patient
Protection and Affordable Care Act (ACA). Milliman helps clients sort through
it all, offering a team of experts with diverse actuarial, operational, and
market experience, spanning decades in the realm of government health care services.
Milliman gives clients an advantage by offering a variety of
differentiators, such as:
Unparalleled actuarial experience. We
develop cost projections and provide financial analysis for the
various Medicaid populations, and we are familiar with and understand all
applicable Actuarial Standards of Practice and American Academy of Actuaries
Comprehensive financial analyses. We
offer comprehensive financial analyses for the Medicaid program,
including current and future financial budgets and the fiscal impact of
Innovative solutions. We
have the expertise and creativity to come up with new paradigms, such as our development
of the Wisconsin Family Care risk-adjustment mechanism, the first of its kind
in the industry. The model relies on the enrollee’s functional needs, rather
than needs based on location.
Our work covers all facets of Medicaid, tapping not only
institutional expertise, but also vast data resources that give clients
actionable choices. Some service areas include:
Managed-care capitation rate setting
and certification. Our consultants apply many different methods and approaches
for setting actuarially sound capitation rates. We use both fee-for-service and
managed-care encounter data, depending on the situation and availability of
data. Our goal is to help our clients develop realistic scenarios that meet their
development. We also allow clients to
focus on making sound business decisions by understanding all facets of the
bidding process. We monitor shifting CMS regulations, freeing clients from
worry about bids being rejected because of technicalities. Our support extends
beyond bid submission, through desk review and audit.
Risk adjustments. We
work with many different diagnostic risk adjusters, including Chronic Illness
and Disability Payment System, Medicaid Rx, DxCG, Adjusted Clinical Groups, and
the CMS Hierarchy for Condition Categories.
Healthcare reform assistance. With rich experience on proposals for state, national, and
international healthcare reform, Milliman can give sound advice on the expected
impact of the ACA for providers, insurers, and governments.
Please contact us to learn how Milliman can help Medicaid stakeholders
better estimate risk, manage costs, and prepare for healthcare reform.