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Implementing One of the Nation’s Largest Medicaid Managed Care Contracts

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Industry

Healthcare

Challenge

Mercy Maricopa Integrated Care faced the formidable task of implementing a start-up health plan under one of the nation’s largest Medicaid managed care contracts, encompassing approximately 700,000 lives. This included providing specialized care to 25,000 individuals with serious mental illness and 20,000 children and youth with severe emotional disturbance.

Results

Hess III Consulting (H3C) facilitated the comprehensive implementation of Mercy Maricopa's health plan. This included strategic facilitation, stakeholder engagement, development of care models, and network development, resulting in a seamless implementation process. The contract value ranged between $4.5 and $7.5 billion, covering extensive care coordination and an advanced care information management system.

Key Product

Health system strategy, Care coordination information systems, Provider network development

700,000
Lives Covered
25,000
Individuals with Serious Mental Illness
20,000
Children/Youth with Severe Emotional Disturbance
$4.5-$7.5B
Contract Value
Arizonan with Serious Mental Illness

About your Customer

With 40-years experience, Mercy Care was the nation’s first fully integrated managed care organization serving individuals with serious mental illness. Today, they are the only managed care organization in Arizona to serve all covered populations including Medicare Advantage, Traditional Medicaid, Regional Behavioral Health Agreement (RBHA), ALTCS, DD, and the Department of Child Safety's Children's Health Program; totaling 500,000 Members. 

The Challenge

Mercy Maricopa Integrated Care was awarded a significant Medicaid contract by the Arizona State Medicaid Authority in 2014. This contract required them to implement a new start-up health plan to serve approximately 700,000 lives, including specialized care for 25,000 individuals with serious mental illness and 20,000 children and youth with severe emotional disturbance. The complexity and scale of this task presented a considerable challenge.

The Solution

Mercy Maricopa Integrated Care included Hess III Consulting on the team to assist with the implementation process due to our extensive expertise in healthcare system design and implementation. Hess III Consulting provided strategic facilitation, stakeholder engagement, development of care models, and network development. According to Robert Hess III, 'Hess III Consulting delivered exceptional expertise and support, making the complex implementation process seamless.' Hess III Consulting's involvement ensured the development of robust care coordination models and the creation of collaborative protocols for multi-system care coordination.

The Results

The collaboration with Hess III Consulting led to the successful implementation of Mercy Maricopa's health plan. Hess III Consulting facilitated the health system strategy/design, developed models of care, internal and provider policies, and created collaborative protocols for multi-system care coordination. They also designed care coordination information management systems and provided network development support. We have celebrated a sustained relationship with Mercy Care for over 12-years.

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