State agencies are under growing pressure to adapt to emerging trends and challenges. Guidehouse helps these agencies improve internal operations as they make other changes to service delivery and financing programs. We conduct organizational reviews and performance audits, evaluate program effectiveness, perform data analytics, and evaluate changes needed in Medicaid Management Information Systems. In addition, our team assesses healthcare IT and helps agencies prevent fraud, waste, and abuse; and enhance program integrity.
Our team has extensive and practical experience managing Medicaid and other healthcare and social services programs. Our consultants are frequently embedded among an agency’s staff to help with day-to-day challenges and implementation requirements, helping staff understand what they need to do differently to improve organizational effectiveness. Our solutions include:
Organizational Reviews We assess current organizational structures and recommend new approaches to staffing in response to changes in delivery and financing, shifting priorities, or fluctuating resources.
Performance Audits We audit performance of your agency against its stated missions and goals and report findings to executive and legislative branches on behalf of state agencies.
Program Integrity We conduct traditional analysis of program integrity functions including an organization's approach to fraud, waste and abuse detection and prevention; and make recommendations to modernize and improve program integrity.
Program Evaluation We manage program evaluations of internal operations, CMS-funded programs, contracted partners and vendors to improve operations and performance. We develop reports to CMS and other agencies to demonstrate access, cost and quality under new programs. The results of these evaluations can vary from complex statistical analyses to survey findings of agency staff.
Data Analytics We develop, design, deploy and maintain data analytics, performance metrics and population health statistics, including all-payer claims database capabilities. We improve your operations through the design of data systems and reporting capabilities; and help you use data to support strategic decision-making.
Medicaid Management Information Systems (MMIS) We translate policy into real changes and upgrades that support payment transformation and managed care implementation. We assist in the evaluation of MMIS changes and adherence to policies and procedures.
Healthcare Information Technology (HIT) We help clients leverage available federal funding into strategic HIT investments to implement new payment approaches, workflows, and organizational structures. We assist clients to use HIT to improve care delivery and outcomes.