The administration of Medicaid is managed by state agencies with federal oversight – a relationship that introduces increased complexities for participating health plans that must meet various federal and state requirements. This becomes even more complex for health plans and other healthcare organizations that have Medicaid business in multiple states with varying requirements. One area where this issue is especially burdensome is complying with the Medicaid requirements for provider enrollment and credentialing across multiple states. In response to this industry-wide problem, a non-profit organization wanted to explore how their existing national solution could be enhanced to support the different state-specific Medicaid credentialing requirements to reduce the burden to these health plans and other supporting organizations.
crankfrog was engaged to complete market research, perform a current state assessment and gap analysis on the existing solution, and create a roadmap that would allow the existing solution to support healthcare organizations struggling to support Medicaid enrollment and credentialing requirements in a streamlined fashion. We created an interview approach and conducted dozens of interviews with Medicaid health plans and supporting organizations of all sizes to better understand their current processes, problem areas, regulatory concerns, and measure interest for a solution that could help address these pain points. This information was used to inform a business case evaluation and product planning activities, considerate of all relevant stakeholder needs.
Through the interview process, crankfrog uncovered significant variation in the industry regarding what Medicaid-specific provider checks were required for enrollment and credentialing, as well as alignment on which point in the process they should be checked. The frequency of continued validation was also found to not be consistent. Furthermore, we discovered that the majority of health plans in the client’s target market were subject to straightforward credentialing requirements that do not impose significant administrative costs; large modifications were not required. Based on these findings, crankfrog drafted a roadmap to allow the client’s sales team to better address Medicaid client questions, improve the solution’s ability to meet customer needs through minor product changes, and further explore broader product enhancements that could support this line of business.