Guidehouse works with state government healthcare and social services agencies to develop rational payment models that balance the need to control expenditures with the need to maintain the quality of care and access to the unique services required by certain populations. We offer a comprehensive set of actuarial and payment transformation services that can be customized in ways that fit each state’s unique needs.
How We Help
- Managed Care Rate Setting
- Directed Payments
- Risk Adjustment
- Waivers, including both Budget Neutrality & Cost Effectiveness Calculations
- Legislative & Budgetary Support
- Data Visualization/Dashboards
- Payment Transformation
- Hospital, Physician, & Nursing Facility Reimbursement Design & Updates
- Upper Payment Limit Demonstrations & Supplemental Payment Programs
- Financing Mechanisms
- Disproportionate Share Hospital Payments
- Value-Based Purchasing
- HCBS & LTSS Rate Development
Latest From Actuarial & Payment Transformation
July 19, 2022 InsightsMost States Require Managed Care Organizations to Implement VBP Models with ProvidersA Guidehouse analysis reveals that more states are requiring the use of value-based payment contracts between Medicaid MCOs and providers. Learn what this means for MCOs, providers, and states.
August 11, 2021 InsightsTelehealth is Key to Achieving Health Equity in Long-Term CareFive strategies for states and providers to embed telehealth into home and community-based services programs.
January 26, 2021 InsightsIt's Time for States to Reshape MedicaidAs states emerge out of the pandemic, “business as usual” will look different for many Medicaid programs.
January 22, 2021 InsightsImprove Home and Community-Based Incident Management Systems to Protect Vulnerable PopulationsStates should consider three key strategies when evaluating current systems and processes in relation to the effects of the COVID-19 pandemic.
November 2, 2020 InsightsNon-Emergency Medical Transportation Post-COVID: An Actuarial PrognosisThree Keys to Avoiding Financial Risk and Preparing for the Future of NEMT Care