Payment Rate Methodology Development & Modeling Services

For state Medicaid and other public agencies, regular review of payment methods helps support their policy goals. Our experts evaluate, recommend, and implement new rate and payment methodologies to support effective and efficient care delivery, enabling the right patient and member health outcomes.

What Challenges You

Agencies, nonprofits, foundations, and other healthcare institutions are tasked with understanding complex concepts, weighing competing parameters, and designing cost-effective solutions to transform service delivery. They need a partner with expertise in financial modeling, deep knowledge of state and federal regulatory requirements, and experience in innovative payment models to support the delivery of excellent care to members and clients.

Why Choose Us

At a time when healthcare is more complex than ever, our team of experts helps clients make sense of financing issues that touch all aspects of care, particularly in publicly funded programs. We bring diverse expertise in health law and policy, deep insight into the healthcare finance landscape, and decades of frontline experience collaborating with state government agencies to improve health outcomes from Medicaid programs. Additionally, our experts can leverage their extensive experience to guide state Medicaid agencies in obtaining demonstration waivers under Section 1115 and home- and community-based services (HCBS) waivers under Section 1915 (c).

How We Can Help

  1. 1

    We help clients develop innovative payment methods to achieve program goals, support complex, vulnerable patient populations, and meet regulatory requirements.
  2. 2

    Our team is highly skilled in modeling how proposed reforms would affect system financing and service delivery.
  3. 3

    We offer rate setting guidance, and support the transition to improved payment systems.

Our Impact

Modeling Complex Care & Compensation

We helped state-funded nursing facilities transition to a payment system that better accounts for the complex care they provide and ensured their state payments meet federal payment requirements. The new and simplified rate structure and payment system resulted in more accurate levels of payments for nursing facilities and enabled them to sustain the provision of quality care to their patients.

Additionally, for one state we offered consultation and modeling for $260 million in hospital payments for uncompensated care to Medicaid and uninsured individuals. Our technical expertise helped ensure regulatory compliance for payments made through a range of financing mechanisms, including disproportionate share allocations, supplemental payment methods, and directed payments.