Driving Innovation and Transformation in Medicare, Medicaid and Other Government Health Programs

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

Member Care & Quality Improvement: Provide comprehensive services related to medical value management, high performing networks and collaborations, and digital/customer experience

Differentiated & Complaint Operations: Develop strategic financial and operational turnaround strategies and deliver op model design, diagnostic and transformation

Innovative, Tailored Products: Provide comprehensive actuarial and data analysis, RFP and bid support, and product + market strategy recommendations

Strategic Growth Initiatives: Create a dynamic and resilient strategy for marketing and member conversion and pre and post merger integration

  • 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
  • Future Cast
  • 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.

Contact us

Amanda Diaz

Partner, PwC US

Mike Longacre

Partner, PwC US

Ashwin Badrinarayan

Partner, Strategy&, PwC US

Deepak Tilani

Partner, Strategy&, PwC US

Thom Bales

Principal, Health Services Sector Leader, PwC US

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