Medicaid Health Plans and MCOs

Since the Affordable Care Act passed, state Medicaid programs have undergone a seismic shift.

Medicaid is covering new populations, and states are launching demonstration programs for health homes, FIDA duals, LTSS and integrated care programs. Traditional Medicaid plans are also launching into the Exchange (HIX) and commercial market to reduce enrollee churn.

Medicaid health plans and managed care organizations (MCOs) have tremendous opportunities, but with those opportunities come ever-greater challenges to improve health outcomes, manage costs, manage complex operations and respond to greater regulatory burdens.

ATTAC Consulting Group provides targeted services to Medicaid plans and MCOs to manage the transition.

Medical and Pharmacy Management

• Model of Care (MOC) development and implementation
• Behavioral health integration
• Clinical pharmacy, formulary and specialty drug management 

Operations and Administration

• Managing requirements for Medicare Advantage duals, MMP and FIDA plans
• Managing complex exchange (HIX) and commercial operations
• Enhancing enrollment and reconciliation operations
• Enrollee materials

Compliance and Audit

• Meeting new state and CMS regulatory requirements 
• Enhancing accuracy of plan reporting
• Compliance testing and auditing