Health and Social Services

Are Intelligent Automation and Blockchain Poised to Disrupt HHS?

This research report profiles where departments stand in their exploration of these technologies, practical use cases within HHS programs, and possible benefits and barriers government organizations may encounter during pilots and implementations.

The Importance of Governance with Incremental Modernization

Enhancing client and case management

The second paper in KPMG's health and human services integrated services delivery series focuses on integrated client and case management, highlighting the opportunities that states have to implement foundational business processes and technology enablers that achieve administrative efficiencies as well as support improved client outcomes.

Life After the Big Bang: Exploring Modular, Agile Paths Toward Health and Human Services Modernization

This research report explores the rapidly changing realm of HHS, unveiling critical insights into goals, challenges, and potential leading practices that lie ahead in project governance, end user support, government-vendor relationships, and beyond

Finding the "right doors" for your clients

The first paper in KPMG's health and human services integrated services delivery series focuses on integrated channel management, highlighting the critical ways states can unlock the power of delivery channels to enhance client self-service, improve customer experiences, drive clients towards the “right door” that benefits them, and realign costs to worker-based activities that will improve client outcomes.

Medicaid strategies for FY19

In an annual survey, Medicaid administrators identified a number of key strategic priorities areas for the upcoming year. This issue brief outlines the five most common areas of focus and provides potential approaches for states to consider.

Squeezing the balloon: The changing Medicaid landscape and rising pharmaceutical costs

With pressure on states to control healthcare costs growth only likely to increase, curtailing the continuous progression of pharmaceutical costs has become a key priority for many state administrations. This paper explores a series of strategies that state Medicaid programs could consider to curb the growth in pharmaceutical spending.

Investing in social services as a core strategy for healthcare organizations: Developing the business case

Despite the widespread acknowledgement of the importance of addressing social determinants of health (SDOH) to improve outcomes and lower medical costs, observed investments tend to be modest in scale and temporary, often funded through time-limited grants or launched as pilots without a long-term strategy. This research-based guide explores the current landscape of investments targeting SDOH as well as approaches to accelerate the uptake of SDOH investments into healthcare business operations.

The path to value: Early lessons learned

This issue brief discusses leading healthcare transformation practices and early lessons learned for how states can embark on their payment reform journeys in collaboration with major stakeholders.

Funding transformation

As momentum builds for healthcare system reform nationwide, this issue brief discusses states' critical first step of planning a financing strategy for Medicaid transformation waivers.

Accelerating healthcare policy outcomes

This white paper explores how to bridge the gap between policy design and implementation by following a set of guiding principles gained through various case studies that utilize structured Rapid Cycle Continuous Improvement programs targeting process improvements by frontline healthcare professionals.

Value-based purchasing strategies for state employees

Four strategies that states can use to increase value by obtaining higher-quality care at more affordable prices for their covered populations

Ten things to know about the Medicaid Enterprise Certification Toolkit (MECT) v2.3

This issue brief outlines the top ten takeaways of the recently released version 2.3 Medicaid Enterprise Certification Toolkit.

New policy guidance on meeting the reuse condition required for enhanced funding of Medicaid Enterprise Systems

This issue brief summarizes the additional guidance provided by CMS in their State Medicaid Director (SMD) Letter # 18-005: RE: CMS-2392-F Mechanized Claims Processing and Information Retrieval Systems—Reuse.

A breakdown of new policy guidance for states: Work/community engagement requirements for Medicaid

This issue brief summarizes and puts into context the work/community engagement guidance provided by the Centers for Medicare & Medicaid Services in the Guidance Letter and briefly outlines key work/community engagement features of Kentucky’s approved demonstration program.

Medicaid Eligibility and Enrollment Toolkit

On August 11, 2017, CMS released the Medicaid Eligibility and Enrollment Toolkit (MEET) version 1.0. This issue brief provides an overview of MEET, explains the difference between the Medicaid Enterprise Certification Toolkit and MEET, and suggests next steps for states to achieve compliance.

How Recent Guidance Impacts State Child Support Enforcement Programs

How Recent Guidance Impacts State Child Support Enforcement Programs

The opioid epidemic: Spotlighting international efforts to address the crisis

While the U.S. may be one of the hardest hit countries in terms of opioid addiction numbers, it is not the only country struggling to control an opioid epidemic. This issue brief focuses on the strategies deployed in other countries, and where available, a reflection of the results achieved to date.

The opioid epidemic: Data-driven case studies

This issue brief explores a number of data-driven strategies that state and local governments have been deploying to combat the opioid epidemic.

The opioid epidemic: A framework for action

The opioid epidemic represents an unprecedented public health crisis in both its complexity and breadth. This issue brief provides an overview of the crisis, four action areas of the solution framework, and considerations for state and local agencies as they seek to address the public health emergency.

Switching gears: Expanding program integrity beyond fraud, waste, and abuse to enhance mission performance

This white paper elaborates on the broad meaning of program integrity in the context of federal healthcare, introduces KPMG’s Program Integrity Framework, and highlights five elements that facilitate program integrity.

The state of oversight and program integrity in managed care

The effective oversight of a state's managed care partners is imperative for a resilient, cost-effective, and high-integrity Medicaid program. This issue brief discusses three key components of managed care oversight and program integrity.

Updating Medicaid managed care: A new CMS rule for quality, transparency, and integrity

This issue brief summarizes CMS's landmark regulation governing Medicaid and CHIP managed care programs and outlines its implications for state Medicaid programs.

Might a 2016 proposal become 2017’s healthcare reform framework?

This issue brief summarizes the components of Speaker Paul Ryan's plan, "A Better Way: Our Vision for a Confident America", analyzes the potential impact to states and the federal government, and provides recommended steps that government agencies can start taking now to prepare for expected changes.

What is, and is not, possible with repeal of the Affordable Care Act?

This issue brief summarizes five key questions that are top of mind for government officials as they consider what is, and is not, possible relative to repeal or replacement of the ACA.

President Trump’s Executive Order on the Affordable Care Act: What it means for government entities

This issue brief provides a short summary of Executive Order 13765, signed by President Trump during his first day in office, to “minimize the economic burden” of the ACA pending its repeal. Also, this brief provides actions for federal and state agencies to consider over the next few months.

Proposed rule on the health insurance marketplace stabilization: What it means for government entities

This issue brief summarizes the proposed rule by the Centers for Medicare & Medicaid Services that aims to stabilize the health insurance marketplace and describes the potential implications for federal and state entities.

Profiles of the new administration: Seema Verma and state Medicaid expansion demonstration waivers

Leadership changes within federal agencies responsible for national health programs can signal new policy and implementation approaches to government healthcare programs. This research brief profiles Seema Verma, nominee for Administrator of the Centers for Medicare & Medicaid Services, and provides a summary of the Medicaid waiver proposals in which she has been involved.