Clients: Managed–Care Purchasing

Bailit Health has assisted over 50 clients since 1997 to improve methods for purchasing or regulating health and human services. A partial listing of these clients can be found below, as well as examples of the types of work that we have conducted for them.

Massachusetts Executive Office of Health and Human Services
Pennsylvania Department of Public Welfare
Texas Health and Human Services Commission
Neighborhood Health Plan of Rhode Island

Client:

Massachusetts Executive Office of Health and Human Services

Challenge:

Massachusetts needed to re–procure its behavioral health organization contract, which provides behavioral health care for MassHealth members enrolled in the Primary Care Clinician Plan and also provides network management for the PCC Plan.

Response:

Bailit provided subject matter expertise in the strategic design of the procurement, lead the drafting of the request for proposals (RFP), including the drafting of the proposal requirements and the model contract, and facilitated the review of the four proposals received by the Commonwealth.

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Client:

Pennsylvania Department of Public Welfare

Challenge:

Assessment internal Medicaid MCO plan management processes and recommend and assist with improvements.

Response:

Bailit conducted a comprehensive review of the state's management of its Medicaid managed care plans and made recommendations for improved policies and practices to better integrate value–based purchasing practices into the state‚Äôs purchasing activities. Bailit then provided some extended technical support to assist with change implementation.

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Client:

Texas Health and Human Services Commission

Challenge:

Introduce value–based purchasing concepts into the state's HMO contracts and contract management process.

Response:

Bailit developed a joint managed care procurement for three different programs that placed special focus on the development of contractor performance measures, performance incentives and disincentives, and allowing the state to set annual quality improvement goals to which the contractors would be held accountable. Bailit also developed contract monitoring tools and recommended policies and procedures for monitoring value–based managed care contracts. Bailit subsequently returned a few years later and assessed adoption of value–based purchasing practices and made recommendations for further refinement.

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Client:

Neighborhood Health Plan of Rhode Island

Challenge:

This Medicaid health plan was required to respond to a re–procurement for long–standing population and also chose to respond to a procurement to provide managed long–term services and supports to dually eligible members.

Response:

Bailit led Neighborhood's successful responses to these procurements, and also served as lead drafter for Neighborhood's application to Medicare, which received a perfect score, to provide acute services to the dually eligible members when Medicare and Rhode Island reach agreement to serve that population.

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