The new Medicare Risk Adjustment model
Learn how PwC can help plans understand the impacts to their Medicare population and evaluate strategies to ensure they are staying ahead of the changes.
U.S. Medicaid and Medicare enrollment and federal spending continue to grow, proving the need for enhanced services. In fact:
- 1 in 5 US citizens are covered by Medicare
- 2 in 5 US children are covered by Medicaid
- ~50% of US health spending is from federal and state governments
- Medicaid/CHIP enrollment has grown over 28% since the start of the pandemic, an increase of over 20 million enrollees since February 20201
- The number of Medicare beneficiaries is projected to grow from around 65 million people in 2020 to nearly 93 million people in 2060
1Analysis of Recent National Trends in Medicaid and CHIP Enrollment
Prepare your Business for Medicaid and Medicare Growth
Our team has the credentials to be your trusted partner and deliver services across the Medicaid and Medicare continuum
Medicaid Strategy: Synthesize outputs from market and capabilities assessments to determine optimal Medicaid strategy and/or build a compelling business case and operational roadmap for market entry
Procurement & Implementation: Understand the bid and procurement landscape, develop and execute state-specific bid strategies, design and build a comprehensive implementation plan, execute implementation and track ongoing performance against quality benchmarks
Population Health Management (PHM) & Value-Based Care (VBC): Incorporate digitally-enabled PHM capabilities and VBC models into operations to drive medical cost efficiencies and improve outcomes
Ongoing Operations & Compliance: Drive effective monitoring and oversight of your plan to sustain high quality operational and compliance performance, leveraging and enhancing core middle office functions
Rate Advocacy: Analyze complex datasets to develop capitation rates in compliance with actuarially sound practices and regulatory requirements
- Detailed RFP Competitor Analysis
- Medicaid Procurement Dashboard
- Automated Reporting and Interactive Dashboards
- Competitor Benchmarking
- AI-Driven Contract Reviews
- Detailed Medicaid Requirements Matrix
- Provider Credentialing Support
… any many more!
- Star Analytics and Reporting
- Medicare Intelli-Hub
- CMS Universe Analyzer
- Product and Market Simulation
- PBP Analytics and Landscape Model
- MA Plan Landscape Evaluator
- Recovery and Resilience
… any many more!
Our dedicated Government Health Team has extensive breadth and depth of experience and includes actuaries, strategists, operations executives, analytics, product / pricing, clinicians / medical directors, and technologists.
The team has an extensive track record helping government plans in strategy, operations, and technology and proprietary thought leadership that can be leveraged throughout engagements.
Insights
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How Medicare Advantage Plans compete
Medicare Advantage plans have emerged as a significant growth driver for the majority of health insurers, reshaping the landscape of healthcare coverage.
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PwC's Health Research Institute podcast addresses health policy topics and regulations like the impact of COVID-19, virtual care, and improving patient experience.
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