Wholesale Conversion to Managed Care

Stemming largely as a result of the Affordable Care Act (ACA) and New York State’s Medicaid Redesign (MRT) process, Managed Care Organizations and Providers are facing a massive and rapid expansion into a managed care model. With the expansion of previously exempt carve-out populations (such as mandatory MLTC or mental health) and National dual-eligible demonstration initiatives, the framework is being established to consolidate services into a single managed care plan (for Medicare, Medicaid, and Dual-Eligibles) and to reward providers for their performance.

Critical Player in Every Phase of the Managed Care Evolution

Beginning with establishing the largest PACE program in the Nation to developing CMS Innovation Office demonstration plans, Loeb & Troper has played a critical role in the evolution of managed care. We have worked with established and new entrants plans in a wide range of issues and continue to play a critical role as plans negotiate performance driven contracts that impact acute, sub-acute and long-term reimbursements, plan for voluntary and mandatory consumers, plan around the ebbs and flows enrollment and disenrollment, and integrate various CMS or State initiatives.

Loeb & Troper is an active leader in assisting payers and providers develop executable strategies as they prepare for Medicare bundled payment demonstrations, Delivery System Reform Incentive Payment program (DSRIP), Value Based Payments program (VBP) or other demonstrations.

Widely acknowledged as a thought leader in the areas of Dual-Eligibles, Integrated Demonstrations and MLTCPs, Loeb & Troper is working closely with the mental health (HARP), substance abuse (HARP) and Developmentally Disabled (DISCO) industries as they prepare for their impending managed care models. We are also working with a full spectrum of providers to transition to managed care.

Managed Care Entities Served:

  • MLTCPs
  • FIDAs
  • Medicare Advantage Plans
  • PACE
  • iSNPS
  • PHSPs
  • DISCOs
  • HARPs
  • Health Homes
  • Care Management
  • Demonstration Projects
  • Government Sponsored Plans
  • Commercial Plans
  • Providers transitioning to managed care

We also offer Managed Care Consulting services »