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

• Actuarial
  
  • 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