Transformation diagnostic for a mixed fee-for-service and managed-care state Medicaid program
We worked with a state Medicaid program to improve quality and health outcomes. By deploying claims analytics, referencing our library of clinical concepts, and mobilizing a team of data scientists, clinicians, operations and IT practitioners, and medical-policy experts, we conducted a diagnostic to pinpoint efficiency-improvement opportunities. Areas we explored included fee for service, managed-care delivery, acute care, long-term care, behavioral health, and Medicaid financing. The long-term-improvement potential we identified ranged from 5 to 10 percent of total program expenditure.