Strategic Health Policy & Care Coordination Consulting

The Menges Group provides services to health plans, provider groups, associations, investors, provider groups, and government agencies. We support several of the nation’s largest Medicaid and Medicare MCOs, as well as with several of the nation’s highest quality-ranked Medicaid MCOs. Examples of client services are provided below:

Helping Health Plans Design Care Coordination Programs for High Need Populations

  • The Menges Group provides strategic support to MCOs in the design and development of new lines of business to serve dual eligibles, including how existing operations can best be reconfigured, which functions (if any) should be handled through partnerships with subcontractors, which models of care are most appropriate for which subgroups, financial projections, positioning for upcoming procurements and proposal preparation (see Proposal Support tab).
  • For health plans and emerging MCOs/ACOs that are seeking to enroll high-need subgroups, The Menges Group performs feasibility assessments and develops business plans regarding what is needed to serve each subgroup effectively.
  • The Menges Group assists numerous clients in the design, implementation and evaluation of new coordinated care programs for high-need subgroups. We have worked extensively on engagements involving dual eligibles, Medicaid-only persons with disabilities, and chronic care subgroups. We are also skilled at assessing existing coordinated care programs for high-need subgroups and helping discern how these programs can be strengthened.

Ascertaining the Impacts of Coordinated Care

 

 

 

  • Our team is skilled at quantifying the cost effectiveness of existing coordinated care initiatives are yielding, and projecting cost impacts for various coordinated care design options. The scope of this evaluative work can be national, state-specific, or focused on a single health plan’s target population. We are highly adept at analyzing claims and eligibility data files to identify specific cost containment opportunities, and designing new initiatives to achieve these savings.
  • Our staff have strong experience discerning opportunities for Medicaid programs to achieve savings.
  • Our staff have assisted various health plans and associations to quantify and demonstrate the value of Medicaid coordinated care programs in a written report for state policymakers. This work includes designing the data collection effort at the front end, compiling/analyzing the qualitative and quantitative information, and drafting and finalizing the report effectively.
  • The Menges Group is visibly involved in preparing reports and conducting presentations to assist policymakers in building and expanding successful care coordination models.
  • We are skilled at working with MCOs to “tell their story,” in conceptualizing and conducting data analyses that demonstrate their value, and in evaluating their operations and preparing recommendations as to how their approaches can be strengthened going forward..

Proposal Support

  • The Menges Group provides extensive procurement support to health plans. Our team is highly skilled and experienced at providing technical and conceptual writing/editing, as well as strategic support to help an applicant prepare its proposal to score as favorably as possible.  We are also experienced at developing or reviewing an MCO’s price proposal.
  • Of the ten Medicaid and dual eligible MCO procurements our staff supported during 2012-2013 (and for which the state agency has announced its decision), all ten clients have been awarded contracts.
  • The Menges Group also assists health plans in their positioning during the several months leading up to the procurement, using this important time frame to the greatest advantage. Whether we are assisting an incumbent client in staying in business, or whether the client is striving to enter a new market or to develop a new line of business in an existing market, these are mission-critical engagements.
  • Towards the end of a proposal effort, we provide staff to review an MCO’s proposal and/or conduct a scoring review – simulating the “fresh eyes” perspective of a state evaluator – to help ascertain how the draft proposal can best be strengthened prior to submission. 
  • Our consultants have experience supporting States as they begin to develop and issue procurements, and review proposal responses.

Policy-Relevant Reports & Analysis

  • The Menges Group is regularly enlisted by associations and other clients to conduct analyses and prepare reports about various aspects of coordinated care in the public arena.  Reports our staff have recently conducted involved:
    • Medicaid pharmacy cost-savings opportunities
    • Medicare Special Needs Plan performance
    • Actuarial soundness dynamics in Medicaid managed care
    • Ramping up use of care coordination for high-need Medicaid subgroups
    • Usage of narcotic medications in Medicaid arena
    • Optimizing care coordination programs for dual eligibles