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Special Populations
The Lewin Group is at the forefront of innovative efforts to serve persons who have special needs in a managed care setting. Our objective for each client is to build an effective, tailored system of care as required by the special needs population. We provide state Medicaid and mental health agencies with assistance in transitioning high-need populations into managed care and disease management programs. We also assist providers, partnerships, and special-interest groups to develop, implement and improve ventures targeted to special needs populations.
Key Services
- Financial and program feasibility assessments
- Program design and development
- Risk-sharing and reimbursement arrangements
- Benefit package design
- Care management system design and implementation
- Consensus building for public and private constituents
- Partnership agreements and contract negotiation
- Waiver application and request for proposal (RFP) technical assistance
- Procurement support, including readiness review of prospective providers
- Quality monitoring and program evaluation
Sample Projects
- Assisted a state in developing special needs health plans to serve Medicaid-eligible persons infected with HIV.
- Developed capitation rates and risk-sharing models for innovative Medicaid managed care programs targeted at elderly and physically disabled subgroups that require long term care services and persons who require extensive mental health and/or substance abuse treatment services.
- Designed three disease management initiatives for persons with AIDS, diabetes mellitus, and hemophilia.
- Supported a managed care organization in developing a successful pilot project proposal to serve children with special health care needs.
- Designed a special needs managed care plan that exclusively enrolls and serves disabled children.
- Modeled the costs of extending Medicaid coverage to uninsured persons who are infected with HIV for five states.
- Assisted a major teaching hospital in developing a proposal for participation in a Medicare managed care demonstration project for chronically ill beneficiaries.
- Supported a state mental health authority in the design of Medicaid managed care Special Needs Plans for children with serious emotional disturbance.
- Assisted a disease management client in responding to a government solicitation regarding congestive heart failure (CHF) patients, including developing a shared risk payment model and analyzing Medicare claims files to develop per member per month cost estimates.
For more information on our special populations consulting, please contact The Lewin Group.
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