With Medicaid, providers and accountable care organizations face a complicated and highly regulated system of requirements put forth by the Centers for Medicare and Medicaid Services (CMS). They must adjust to rising pressures for cost containment and improve performance at the same time. Success in this changing environment requires clinical, data, analytical, and financial sophistication. Milliman’s broad perspective and vast data resources allows providers maximize Medicaid reimbursements, while raising the efficiency of care delivery.

Milliman helps providers and ACOs in areas such as:

• Benchmark development.

  Milliman benchmarking reports provide practical advice for setting targets for improvement. We conduct scenarios to test different levels of utilization their impact, identifying areas of strength and weakness, which help to uncover gaps in performance. Milliman can examine a provider’s overall experience or a particular subset, such as line of business, group, or diagnosis. We help providers in the critical task of choosing which results or processes should be benchmarked—or can be benchmarked.

• Budget development.

  Milliman consultants are operations experts who can help providers develop budgets and rating targets for providers. We assist providers with understanding the administrative implications of various policy decisions and design management plans for executing state Medicaid requirements. We assist clients with the big challenge of selecting revenue and making sure providers disperse the revenue to doctors and a hospital’s various types of medical servicers.

• Provider reimbursement analysis.

  We also help hospitals evaluate reimbursement arrangements as changes come through the states and CMS. We can give providers a snapshot of how old and new systems compare, and what the financial implications are.

• ACO consulting.

  More hospitals and physicians are joining forces to create their own accountable care organizations, giving them more control over how they provide care to the Medicaid population. Yet they also face greater risk. We can help ACOs work directly with their state, performing similar functions we provide to health plans, such as benchmark development, budget development, risk-based capital requirements, claim reserving, and provider reimbursement.

• Risk-based capital requirements and claim reserving.

  Milliman also assists ACOs determine how much capital they need going forward, and how much physician’s and hospitals groups need to start an ACO.