State Health Transformation

Deloitte provides services from strategy and design to implementation and operations as states transition to value-based care. Deloitte brings developed project accelerators to advance the design and implementation of Medicaid value-based care based on its experience in several states.

Services include:

• Vision, strategy, and program design – Facilitation services to set vision, strategy, and program design
• Operational design and implementation planning – Detailed design services focused on transitioning from program design to an operational design, then planning implementation based on that design
• Actuarial modeling and rate-setting – Modeling to support program design and operations
• Project management and implementation support – Project support throughout implementation across business-process, technology, and organizational changes

Methods and tools:

• Governance models
• Member plan assignment strategies

Deloitte provides strategic advisory services and technology strategies to address current and future program needs. Deloitte’s tailored methods provide end-to-end support, from research, visioning, and design to implementation.

Services include:

• Providing leading-practice recommendations to support state policy, technology, and financial decisions for statewide HIT strategy
• Formulating technology strategy recommendations
• Developing statewide HIT strategy
• Developing implementation planning road maps and HIT-enabled quality measurement programs
• Facilitating stakeholder working sessions to plan, review, revise, and finalize

Methods and tools:

• HIT environmental scan
• Implementation planning with a multi-phased road map
• Medicaid technology strategy
• MES life cycle management (MLM) toolkit
• Certification assessment tool
• MES and HHS business process models
• MES integration playbook
• Application life cycle management (ALM) tools
• EVD Agile SI methodology

Deloitte helps states to design strategies, implement and operationalize programs, and develop and implement technologies to address the social conditions that drive health while being responsible stewards of resources. Deloitte’s data and analytics can identify the social drivers of health (SDOH) to help understand the opportunities to improve the delivery system.

Services include:

• SDOH strategy development through stakeholder engagement, data analysis, and policy research
• Program design assistance with waivers and state plan amendments
• Project management and implementation support
• Medicaid MCO contracting strategies
• Technology solutions to connect individuals with social services and supports

Methods and tools:

• Strategy alignment and stakeholder engagement
• Access to self-service portals and a “person-centric” approach to service
• Actuarial models to incorporate social factors into Medicaid payment models
• Advanced analytics to detect and predict SDOH risk factors and align interventions

Deloitte employs cross-cutting capabilities to combat the opioid epidemic. Our methods and tools span identification, treatment, enforcement, and prevention approaches to this issue.

Services include:

• Advanced predictive analytics to identify at-risk populations and tailor interventions
• Artificial intelligence (AI) to improve quality, speed, and functionality
• Access to services and care through improved operations
• Population health management based on insights gleaned from data analyses
• Investigative targeting from data and predictive analytics capabilities

Methods and tools:

• Opioid360™ is a solution to protect lives and conserve resources in the fight against the opioid epidemic. Health, human services, and law enforcement experience meet advanced analytics to better answer the questions of who is at risk of opioid use disorder (OUD), how we can address opioid abuse, and what the barriers to treatment are.
• Disease state model to identify those at risk as early as possible

Deloitte supports state Medicaid cost initiatives, bringing innovative ideas and leading practices across the nation.

Services includes:

• Cost driver analytics
• Cost containment ideation
• Programmatic and operational reviews
• Coordination and implementation of cost containment initiatives

Methods and tools:

• Actuarial models and analytics to conduct a deep dive across programs, populations, and services
• Cost containment inventory generated from national Medicaid and commercial health care market strategies on cost control and containment

Deloitte helps states design, improve, and implement innovative and executable Medicaid and individual market programs that target full transformation and reform.

Services include:

• Program design assistance with waivers and State Plan Amendments (SPAs)
• Rate-setting and benefit design
• Options development and modeling
• Section 1115 waiver development
• Section 1332 waiver development
• Budget and deficit neutrality modeling and development

Methods and tools:

• Health care actuaries and models to support waivers, health reform, and value-based care
• National Medicaid policy and process inventory of leading practices
• Policy integration analysis framework
• Packaged technology products that accelerate implementation, such as an 1115 waiver cloud-based personal accountability solution

Deloitte provides a variety of services to help states redesign their behavioral health systems.

Services include:

• Rate-setting and benefit design
• Program design assistance with waivers and State Plan Amendments (SPAs)
• Managed care readiness reviews and implementation support
• Provider readiness tools and training

Methods and tools:

• Actuarial models to support waivers, health reform, and value-based modeling
• Operational and performance dashboards
• Medicaid managed care implementation checklists
• Readiness review tools
• Predictive models for provider financial performance
• Data reports to track claims payment

Deloitte leverages its understanding of organizational and workforce needs to transition state organizational and operating models.

Services include:

• Organizational alignment to strategy and business model
• Guided process and organizational structure redesign

Methods and tools:

• Organization design methodology – Three-phased, business-oriented approach focusing on organization-specific needs

Deloitte’s credentialed health actuaries lead Medicaid reimbursement, policy and financial analysis, analytics, and strategy needs. Deloitte uses a variety of tools and methodologies to support actuarial engagements based on years of experience supporting states in Medicaid financial and policy initiatives.

Services include:

• Capitation rate development
• Policy and financial impact analysis and modeling
• Risk adjustment
• Cost containment and program management
• Risk mitigation approaches
• Modeling with advanced analytic capabilities
• Financial dashboards and monitoring
• Encounter data quality and improvement

Methods and tools:

• Capitation rate development
• Emphasis on collaboration with state stakeholders and transparency to health plans
• Consistent with CMS requirements and ASOPs
• Standardized approach and models for rate development, financial analysis, trend, and admin models
• Risk adjustment processes

Deloitte provides strategic planning, design, and implementation services to support Medicaid agencies with advancing quality goals and objectives and better managing costs. Deloitte applies several methods and tools to accelerate a Medicaid agency’s ability to obtain more value from managed care plans and providers.

Services include:

• Development of Medicaid quality strategy detailing quality vision, goals, evidenced-based interventions, and implementation road map
• Implementation of quality strategy, including quality measure development, benchmarking, analysis, and stakeholder engagement
• Implementation of processes and tools to regularly monitor, report, and evaluate quality for continuous improvement

Methods and tools:

• Quality strategy framework
• Strategic visioning session guides and materials
• Evidence-based and best-practice interventions and quality measures
• National, regional, and local benchmark data
• Measurement and evaluation plan templates

Medicaid agencies are constantly exploring ways to streamline case management and service delivery to enhance the client experience. Even with modernized eligibility systems, effective client service and optimized processes can remain elusive goals because the amount of time spent on transactional work (scanning, imaging, data entry, and routine communications) limits the amount of time available for analysis and innovation. Deloitte’s Robotics and Intelligent Automation (R&IA) solutions can help state Medicaid agencies reduce the administrative transactional burden on caseworkers, free up staff time to address more complex cases, and focus on high-quality client interactions.

Methods and tools:

R&IA has helped Medicaid agencies reengage their core mission to put customer service at the center of Medicaid delivery:

▪Robotic process automation (RPA) can mimic human actions and replicate them at a faster rate and with greater accuracy.
▪Intelligent optical character recognition (I-OCR) helps clients identify, sort, and digitize information in their management systems, reducing time-consuming work, decreasing errors, and digitizing downstream processes.
▪Predictive and cognitive automation are statistical techniques that automate analytical model-building using algorithms that iteratively learn from data without the need for explicit programming.

Deloitte offers end-to-end 1115 and 1332 waiver support services, applying proven methods that have supported 20+ waivers from strategy and design to operations.

Services include:

• Strategy and design
• Waiver development
• Fiscal modeling and budget neutrality
• Negotiations with CMS

Methods and tools:

• Environmental scan
• Stakeholder engagement and public comments
• Waiver implementation and operations

Deloitte helps states focus on the growing challenge of managing LTSS and HCBS programs. Deloitte offers tools tailored to connect HCBS and LTSS clients to necessary care and to provide oversight for states.

Services include:

• HCBS waiver service management
• LTSS and HCBS program redesign
• Strategy development and implementation support for transitioning to managed care
• Strategy development and implementation support for HCBS Final Rule transition
• Provider network adequacy assessment

Methods and tools:

• HealthInteractive Consumer Connect – A cloud-based program and case management CoTS solution
• HealthInteractive Medicaid Program Oversight Portal – A cloud-based provider network analysis and adequacy solution

Deloitte helps states improve their operations, increase efficiencies, and address regulatory requirements. We provide insights to enable better, more informed decision-making and stronger operational effectiveness.

Services include:

• Strategic options analysis
• Strategic road map development
• Operational analysis
• Regulatory compliance reviews and gap analyses
• Business process redesign
• Cost savings alternatives
• Operations management and tracking

Methods and tools:

• Smart regulation tool
• Business process mapping
• Operational and performance dashboards

Deloitte’s Results Management Office (RMO) supports state Medicaid agencies in achieving the successful delivery of program objectives through our framework that provides a standard and repeatable approach. Deloitte’s approach and tools provide a structure for governance, oversight of project schedules and work plans, risk and action item tracking, and continuous quality improvement.

Services include:

• Strategy and mission alignment
▪ Investment planning
▪ Benefits and results management
• Domain authority
▪ Business process management
▪ Technical integration
• Organizational readiness
▪ Stakeholder engagement
▪ Change management and training
• Program management
▪ Governance and reporting
▪ Risk and issue management

Methods and tools:

• Enterprise value delivery
• Atlassian JIRA to manage action items, decisions, risks, and project tasks
• Project Management Center (PMC) to facilitate project managements

Deloitte assists states in better engaging Medicaid recipients with their health services and benefits and provides key insights into recipient use patterns.

Services include:

• Analytics that identify recipient needs for program design, delivery, and evaluation
• Reducing recipient burden, improving buy-in and engagement, and making efficient use of resources through user-friendly systems
• Enabling recipients to search for critical services, such as physicians, food pantries, and opioid recovery centers, through a single platform
• Allowing recipients to provide timely feedback to Medicaid agencies
• Setting up virtual profiles for Medicaid recipients
• Empowering recipients to make an informed choice for a Medicaid health plan

Methods and tools:

• Medicaid Buddy – An integrated mobile application developed by Deloitte that has the following features:
• Eligibility and enrollment
• Finding a provider
• Creating and managing appointments
• Drive meaningful integration of social and medical program platforms to facilitate the targeting and delivery of needed resources
• Facilitate person- and family-centered care in care delivery settings to improve outcomes and the experience of care

Deloitte supports state contract managers and executives in tracking and monitoring MCOs. Deloitte provides state contract managers a common, web-accessible platform and tools to perform MCO monitoring functions.

Services include:

• Developing policies, processes, performance measures, and standards
• Developing automated oversight and reporting mechanisms
• Conducting MCO training and adoption of new processes

Methods and tools:

• Medicaid Program Oversight Portal
• MLTSS (Managed Long-Term Services and Supports) Quality Portal

Deloitte supports managed LTSS oversight through a coordinated model to help states improve outcomes and quality while controlling costs.

Services include:

• Managed care organization monitoring
• Consumer experience monitoring
• Program management – Services such as general tracking and reporting, health quality monitoring, identifying risk, and ensuring MCO compliance

Methods and tools:

• Health Interactive Portal – Cloud-based portal that provides program and population oversight of MLTSS. Some features of the portal include:
▪View consumer population, distribution, and related changes across delivery programs and MCOs
▪Review planned vs. utilized services
▪Determine if the program is driving behaviors that are stabilizing and improving the overall health of consumers
▪ Identify unmet consumer needs and potential gaps in MCO provider network adequacy

Deloitte supports Medicaid transportation programs’ reimbursement, strategy, and analytics needs.

Services include:

• Transportation reimbursement
▪ Capitation rate development
▪ Administrative claiming and cost allocation
▪ Program monitoring and forecasting
• Program strategy
▪ Program design and strategy development
▪ Transitions to regional and statewide broker models
▪ Private and public stakeholder engagement
▪ Waiver and program development
• Analytics and modeling
▪ Budgetary analysis and data visualization
▪ Cost report development
▪ Procurement support

Methods and tools:

• Capitation rate development models
• Full-risk broker procurement cost proposal templates
• Waiver cost-effectiveness template and standardized response narratives
• Transportation stakeholder engagement question-and-answer templates
• Response methodology to support CMS waiver and cost allocation negotiations
• Structured logic for monitoring key transportation performance indicators