An experienced approach for your new focus of growth.
Public-sector programs that fund and regulate government health care programs are more important than ever for most plans. Medicare, Medicaid and dual-eligible members will make up more of your business and, you can’t operate within the value chain it takes to serve them—from strategy to operations to compliance—without interacting with the government.
In this environment of high-stakes change and growth, many health plans are scrambling to stand up their approaches to government health programs. Deloitte’s top-ranked health plans practice stands apart with mature, first-hand, practical knowledge of government programs based on years of investment and involvement. Our practitioners have deep experience not only with Deloitte, but also in federal and state health care programs as well as access to Deloitte’s public- and private-sector specialists.
Our multidisciplinary approach can help broaden your government-sponsored business and make it more profitable.
- Strategy. From an assessment of your competitive landscape to product and benefit design, our qualitative and quantitative tools help you make the big decisions that frame other decisions.
- Performance improvement. When you’re launching a new product, completing a Medicare Advantage application or a response to a State Medicaid RFP, expanding into a new service area, or working to improve your operations, you need the insights that drive better plan performance and improved member satisfaction and health outcomes.
- Medicare Stars. Improving your Medicare Star rating is one of the best ways to boost your health plan’s profitability. Deloitte’s programs provide competitor comparison tools and concrete assessment and action plans that can help you improve your Star ratings revenue.
- Organizational design and resource modeling. As you grow to serve these expanding government programs, we can help you assess how many people you need where—and assess how to design your organization to drive government programs growth and performance.
- Revenue. Knowing the ins and outs of risk adjustment and the regulations that govern these payments helps get the most reimbursement you can while staying on the right side of the rules.
- Other services including fraud, waste and abuse detection and prevention program assessments; technology services support, such as vendor assessments; platform migration; and compliance evaluations, such as mock and operational readiness reviews.
Our teams supplement these services with a number of proprietary tools to help address complex problems like risk adjustment optimization, prescription drug event analysis and Star ratings analysis.
Unlocking the potential in government programs doesn’t just take members—it takes profitable members and effectively managed programs. To bring products to market that serve that growing cohort effectively and efficiently, you need to combine many threads of knowledge into a single, coherent strategy, including creating programs and efficiencies to help make non-profitable members profitable.
Select services that support government programs clients include:
|Lucia Giudice, Director, Deloitte Consulting LLP|
|Tom Delegram, Senior Manager, Deloitte & Touche LLP|
|Jack Scott, Director, Deloitte & Touche LLP|
As used in this document, "Deloitte" means Deloitte LLP and its subsidiaries. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.