The Centers for Medicare & Medicaid Services (CMS) proposed last month a new set of rules for Managed Medicaid with the intent to alleviate some of the coverage and access challenges that face the States and their Medicaid populations, as well as align Managed Medicaid to Medicare Advantage and market standards.

Global Head, Health Services, Oliver Wyman
Global Head, Provider, Health & Life Sciences, Oliver Wyman
Partner, Health & Life Sciences, Oliver Wyman

Medicaid enrollment across the United States currently encompasses ~50M individuals, of which ~40M are enrolled in some form of Managed Medicaid. The covered population is expected to continue to grow, driven by factors such as Medicaid expansion, population growth, and economic challenges in select States.

Global Head, Health Services, Oliver Wyman
Partner, Health & Life Sciences, Oliver Wyman
Partner, Health & Life Sciences, Oliver Wyman

While recent reports have noted its slow start, Oliver Wyman’s Martin Graf, Jim Fields, and Parie Garg provide an update on the CMS demonstration program "Fully Integrated Duals Advantage program" and discuss where its potential lies.

Global Head, Health Services, Oliver Wyman
Partner, Health & Life Sciences, Oliver Wyman
Partner, Health & Life Sciences, Oliver Wyman

Jim Fields, Parie Garg, and Oliver Wyman’s government programs team share a slide from a recent project detailing a chronic care model featuring a clinic to help address the special needs of high-risk patients through the integration of physical health, behavioral health, and social support services.

Global Head, Health Services, Oliver Wyman
Partner, Health & Life Sciences, Oliver Wyman

Governors around the country have recently announced plans to restructure their Medicaid programs in ways that affect the care of people with intellectual disabilities, mental health and behavioral problems, and other recipients of long-term care. Oliver Wyman's government programs experts Jim Fields and Parie Garg take a closer look at contracting opportunities in the Home and Community-Based Services market.

Global Head, Health Services, Oliver Wyman
Partner, Health & Life Sciences, Oliver Wyman

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In many ways, Medicare Part D, the program that provides seniors with prescription drug coverage, has been a great success. Yet, while the program has essentially been a win for consumers, it has been a gauntlet for plans. Oliver Wyman Partner Jim Fields explains in “The Part D Dilemma” why it can be so hard.

Global Head, Health Services, Oliver Wyman

Smaller health plans trying to compete on Medicare Part D are finding the deck stacked against them. One of the biggest challenges is the extreme price sensitivity of the Prescription Drug Plan market, as illustrated by this infographic.

Global Head, Health Services, Oliver Wyman

Medicare Part D presents a bit of a conundrum for health plans. It’s in high demand and a gateway to larger opportunities, yet significant profitability challenges make it difficult to run solo. In a new paper, Oliver Wyman Partner Jim Fields describes why Part D is so difficult and how health plans can minimize the risk and maximize the benefit of remaining in this essential line of business.

Global Head, Health Services, Oliver Wyman