Services for Private Sector Organizations

Program and Product Development

Consulting services to assist in the evaluation of opportunities for participating in Medicaid and State Child Health Insurance Plan (SCHIP) programs

• Program evaluation

• Corporate capacity analysis

• Resource requirements

• Financial analysis

• Proposal development

Technical assistance in developing all aspects of specialized managed care programs for Medicaid and SCHIP beneficiaries, including:

• Member Services

• Member Outreach and Education

• Provider Network development

• Grievance and Appeals functions

• Case and Disease Management programs

• Quality and Utilization Management programs

Technical assistance with all aspects of developing specialized managed care programs for:

• Physically disabled adults and children

• Seriously Mentally Ill adults

• Seriously Emotionally Disturbed children

• Long-Term Care populations

• Dually-Eligible (Medicare/Medicaid) beneficiaries

Procurement Assistance

Review and critique of Requests for Proposals from public agencies

Development of proposals in response to competitive bid processes by public-sector entities:

• State Medicaid Agencies

• Public Employee Insurance Agencies

• Centers for Medicare and Medicaid Services (CMS)

Development of capitation rate proposals

Performance Monitoring

Analysis of HEDIS data

Identification of Plan-specific Performance Measures

Design and Implementation of Performance Monitoring Strategies and Processes

Design of Performance Monitoring Reports

Development of Provider Report Cards

Design and Execution of Member and Provider Satisfaction Surveys

Analysis of Member and Provider Satisfaction Survey data

Program Readiness

Conduct of "mock" site visits (Medicaid managed care and Medicare+Choice)

Development of Corrective Action Plans