Client Results: Insourcing a Medicaid Star/Chip Program to Save on Vendor Fees

Successful go-live completed on time and below budget enabling the client to take charge of their health plan, explore growth opportunities and minimize vendor fees.

Challenge

The client desired to insource their 40,000 member Medicaid STAR and CHIP line of business that was being managed by a vendor. The client was challenged with limited resources and an extremely aggressive timeline of 9 months.

Solution

ProspHire performed a comprehensive current-state assessment to understand organizational impacts, gaps and regulatory state requirements. The ProspHire team used their findings to curate an aggressive implementation roadmap and lead the execution. The team provided end-to-end support with accreditation, vendor management, system configuration and implementation, state readiness and general health plan operations.

Result

As a result, the client’s go-live was successful, completed on time and below budget. This achievement enabled the client to take charge of their health plan, explore growth opportunities and minimize vendor fees associated with business management. ProspHire enabled the client to pass state readiness and successfully in-source their Medicaid STAR and CHIP line of business. ProspHire delivered a comprehensive transition plan to help continue support their Medicaid STAR and CHIP line of business. The transition plan will support future business and technology operations with a clear path to expanding into additional regions as well as future vendor implementations.

Deliverables

HHSC Compliant Medicaid STAR and CHIP plan
25+ Net New Vendor Contracts and Relationships
Scalable Staffing and Governance Model
Value-Added Benefit Selection
State-compliant member website
Reduced vendor fees
Opportunity for expansion

Client Overview

The client is a small to mid-size Health Maintenance Organization (HMO) that offers coverage to members in the state of Texas. They serve CHIP and STAR Medicaid-eligible individuals, including newborns and pregnant or new moms.