FCG specializes in developing innovative payor and provider partnerships and programs that build on the unique strengths of our clients
Areas of policy focus include:
- Advanced payment models and shared incentives
- Design of Medicaid ACO programs
- Programs and payment models for Medicare-Medicaid dual eligible populations
- Development of policies and programs for state-based exchanges
- Leveraging opportunities for federal funding in program design
- Facilitating community/stakeholder involvement in program design
Recent projects have included:
- Equity in Accountable Care Organizations: Established targets for each ACO performance metric based on historical performance, trends and benchmarks. Created and implemented population specific sub-targets for key cost and utilization metrics based on identified race/ethnicity disparities using FCG’s proprietary “close the gap” approach
- Medicaid COVID-19 Response: Assessed the financial viability of nursing facilities and home health providers during COVID-19 pandemic. Developed programs to distribute federal relief funding to improve infection control, support staffing stabilization, and encourage nursing facilities to transform their business models.
- Behavioral Health Policy Gaps and Payment Model: Completed a statewide analysis of behavioral health and substance use gaps in Rhode Island’s payment and delivery system through an equity-focused lens. Conducted focus groups and key informant interviews with state agency leaders, subject matter experts, provider organizations, and community stakeholders. Developed programs and payment models responsive to identified gaps.
- Value Based Payment Models for Medicaid Funding: Led a public input process toward the initial design of the Rhode Island Accountable Entities Program and Value Based Payment Model. Developed innovative funding model, leveraging DSHP authority structure and university expenditures, to support payment model innovations for a state Medicaid agency
- Medicaid ACO programs: Designed and facilitated the implementation of a Medicaid ACO program for a state Medicaid agency. Within this program, developed alternative payment models that create appropriate financial incentives and rewards for payors and providers
- Dual Eligibles: Designed and implemented programs and payment models for Medicare-Medicaid dual eligible populations
- 1332 Waivers: Designed and developed a 1332 waiver program for a state-based exchange, establishing both a reinsurance program and a state-based health insurance mandate
- Tiered Rating Structure for Assisted Living: Designed, developed and implemented a tiered acuity-based rating structure for Medicaid certified assisted living facilities.
- HCBS Payment Models: Designed and developed payment model enhancements for home and community-based providers to support targeted rebalancing goals.
- Hospital Care Transitions Program: Designed, developed and implemented a multipayor Hospital Care Transitions Program, targeting populations at risk for post-acute long term care services
- Social Determinants of Health: Supported the design and development of a Medicaid ACO’s Flexible Services Program for housing-related social needs and a nutrition program, including stakeholder engagement, developing budget and return-on-investment analysis, and drafting application for funding