Guidehouse helps states manage, streamline and reform their largest budget expenditure, Medicaid, through a number of tailored solutions. We help states implement value-based payment systems, including Medicaid managed care and other waiver programs, and support programs that integrate physical and behavioral health, as well as long-term services and supports (LTSS) programs.
Our knowledge of leading practices and practical experience working with key state and government agencies provides a rich perspective that we are able to share with all our clients. Our solutions include:
Delivery System Reform
We support states in considering options for reforming their Medicaid programs to achieve higher quality in a cost-effective manner. We provide extensive subject matter expertise, conduct national and state-specific environmental scans, and facilitate stakeholder outreach activities to obtain input on potential reforms. We develop reports of findings and provide recommended options for reforms.
We write waiver submissions to CMS, including 1115, 1915 and 1332 waivers. We help manage implementation of waiver programs, including developing ongoing contract monitoring strategies and reporting tools, assist states with CMS negotiations to obtain approval.
Medicaid Managed Care
We assist states with assessing their compliance with new CMS managed care regulations. We design procurement documents; provide support on stakeholder engagement; assess provider network adequacy, performance measures, stakeholder communication, contract development, federal compliance; assist with readiness reviews and corrective action plans, and assist with the full spectrum of managed care design, implementation and contract monitoring. We evaluate and implement pay-for-performance programs.
Managed Care Organizations
We assist managed care organizations (MCOs) to develop strategies and meet contractual requirements for government healthcare program requirements. We address issues including network adequacy, compliance, care/case management requirements, and medical loss ratio guidelines in conjunction with the Medicaid managed care final rule.
State Innovation Models Initiative
Guidehouse helps states using State Innovative Models funding to implement the program’s payment transformation agendas through program design, data analytics, performance metric development, and program effectiveness monitoring, evaluation and system design.
We work with states to integrate acute and behavioral health services, facilitating more coordinated care with less duplication, and better care management and outcomes. We offer a number of services to support this transition, including program design to educate primary care physicians about behavioral health issues and the need for coordinated care.
Develop Approaches for Medical Homes, Health Homes, and Patient-Centered Medical Homes
We develop and design programs and financing strategies, support implementation and monitor programs. We also develop curriculum and train physicians and their staff on issues related to medical homes.
Latest From Medicaid Reform
January 5, 2022 Insights4 Secrets to Managing Vulnerable PopulationsMaking fast improvements in population health is critical, but it requires a strategic approach to enrollment growth, experts shared during Guidehouse’s 2021 Clinical Integration Summit.
November 8, 2021 Infographic2021 Risk-Based Healthcare Market TrendsA Guidehouse analysis of an HFMA provider executive survey points to health system trends in risk-based payment models, payer/provider partnerships, and budget outlooks.
September 30, 2021 VideoGuidehouse's 2021 Clinical Integration Summit On DemandHealthcare leaders discuss the impact of disruption on healthcare and how to leverage it to optimize health system network strategies.
June 29, 2021 Case StudyTennCare Reduces Costs, Improves Outcomes Through Primary Care TransformationThree-year initiative with Guidehouse to integrate behavioral health with primary care reduces costs and improves member outcomes for Tennessee’s Medicaid agency.
November 23, 2020 InsightsWhat States Need to Know About the Downstream Impacts of Inadequate Behavioral Health TreatmentWith COVID-19 cases on the rise, significant behavioral health treatment needs and access barriers remain major threats to overall health and taxpayer dollars.
April 13, 2020 ResearchSummary of Pending and Approved Section 1115 Demonstration Waivers for StatesAssisting with COVID-19 Public Health Emergency and Other Disasters