Healthcare

Effectively managing recipients' care provides the greatest opportunity for addressing the significant cost burdens faced by government healthcare agencies. On average, more than 95 percent of a government agency's program budget goes toward the cost of care, while five percent or less goes toward program administration. State, local and federal health agencies need a partner who has the experience, expertise and technology to deliver solutions that enable better health outcomes, improved quality, and reduced cost of care.

ACS' suite of modeling, profiling, benchmarking, reporting and health risk prediction tools is considered among the most innovative in the industry to monitor and manage trend. Our case, care, and quality management approach uses clinical expertise and a portfolio of technology management tools to provide Emergency Room Diversion, Prior Authorization, Medical and Psychiatric Case Management, Disease Management, and Disability Case Management.

ACS is one of only a handful of companies that holds Utilization Review Accreditation Commission (URAC) certifications for utilization management, case management, disease management, and workers' compensation case management. URAC is an independent, nonprofit organization that is considered a leader in promoting healthcare quality through its accreditation and certifications programs.

In addition, ACS is a designated QIO-like entity through the Centers for Medicare and Medicaid Services (CMS).  As a prospectively and retrospectively designated QIO-like entity, ACS provides utilization review and health quality management services to state Medicaid agencies across the country and works with consumers, providers, hospitals, and other caregivers to ensure that beneficiaries get the right care at the right time.

Read more about our population health management and health information technology capabilities here and here. 

As pharmacy costs continue to grow at double-digit annual growth rates, so do the pressures on government healthcare officials to implement and manage a successful pharmacy assistance program. Adding to the mix, many state Medicaid programs nationwide are challenged with budgetary concerns, changing federal requirements and healthcare access issues—requiring reform agendas that encompass both policy and technology. Recognized by public sector pharmacy benefit programs for the development, management and administration of superior technical and clinical solutions, ACS can provide state governments with a combination of customized solutions to meet pharmacy program goals.

ACS continues to innovate in the pharmacy benefits market, partnering with our customers to contain costs, improve drug therapy, advance their programs forward and deliver the highest value possible to the consumers. Currently serving 32 programs in 28 states, ACS can deliver cost-efficient results with scalable solutions that serve the needs of both state government and healthcare-dependent constituents.

In 2009, the nation’s Medicaid programs will pay an estimated $390 billion to physicians, hospitals, nursing facilities, health plans and other providers.  In many cases, the old ways of setting rates, such as percentages of charges, cost reimbursement, and static fee schedules, have not done a good job for payers.  Many states are looking for methods that will do more to encourage cost efficiency, access to services and quality of care.

ACS can help. As the fiscal agent or facilities manager, ACS is uniquely positioned to help Medicaid programs develop their payment methods, which must operate within complex claims processing systems. Unlike many consultants, we already have in-depth knowledge of your MMIS, your Medicaid program and your providers.

Examples of projects that ACS can perform:

• Assess current payment methods and develop options for improvement
• Assist with a transition from inpatient payment methods no longer suitable for Medicaid, such as Medicare’s CMS-DRGs or MS-DRGs, to more sophisticated and appropriate methods
• Design and implement methods to pay for outpatient hospital care
• Develop or review fee schedules for services provided by physicians, therapists, dentists, and ambulance providers
• Create incentives to provide quality care
• Assist with administrative rules, state plan amendments, advanced planning documents, provider consultation, provider manuals, and technical documentation
• Designing and implementing nursing home cost settlement and rate setting systems

ACS can assist its clients with payment method tasks ranging in scope from several dozen hours to several thousand hours. For most payment method projects, we combine fiscal agent staff from the client state (business analysts, programmers, provider relations) with ACS payment method specialists at the national level to meet your specific needs.