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Enabling more accessible and higher quality healthcare for the state Medicaid population

The Ripples Group supported a state Medicaid agency redesign its operations to meet the requirements of the Affordable Care Act and transition its existing and new members to the new coverage plans with no interruption in service.

Following the state adoption of the Affordable Care Act (ACA), The Ripples Group was retained to manage the federal health care reform for the state Medicaid agency. Working closely with multiple state government stakeholders, IT experts, and customer service organizations, Ripples established a governance structure to facilitate executive-level decision-making, to mitigate risks, and to expedite issue escalation and resolution.  In parallel, through collaboration with subject matter experts at the state agency, Ripples developed analytical tools to monitor the progress of multiple workgroups encompassing policy development, member eligibility, operational and administrative innovation, program integrity initiatives, and ACA demonstrations. 


Subsequently, the Ripples Team collaborated with the state to determine the future-state objectives on critical ACA initiatives such as Member Transition, Customer Service Strategy, and MassHealth Field Operations.  In each case, Ripples consultants started by defining the current state through an analytical fact base.  Through extensive research, CMS guidance, and discussions with the respective workgroups, realistic projections were put together, pressure-tested for various scenarios, and refined.  Finally, a road map that bridges the gap between the current and proposed future-state business processes was formulated. 


Notable accomplishments include:


  • Flawless member transition for more than 1.5 million Medicaid beneficiaries

  • Project management of 25 workgroups from various organizations including daily risk mitigation and conflict resolution

  • Creation and roll-out of an operational manual to assist Field Operations in implementing the new program

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