CERTIFICATIONS

• Strategic Communications Plan Development
• Curriculum Development
• Computer-based Training
• Train-the-Trainer Guides
• Communications and Public Relations
• Content Development
• Survey Instrument Design and Administration
• Focus Group Facilitation
• Benchmark Analysis

“The accuracy and volume of materials produced on time across highly technical program areas and their eye-catching visuals are a testimony to the breadth and depth of staff’s skills, competency, and knowledge. Rainmakers is nimble in its ability to respond to changes in direction without missing a beat, acquiring additional resources quickly and seamlessly incorporating them into ongoing operations.”

– Centers for Medicare & Medicaid Services (CMS)

Scenario

Client Challenge

The Centers for Medicare & Medicaid Services (CMS) desired to strengthen their anti-fraud efforts by launching an outreach and education program to provide training to anti-fraud professionals and outreach to build awareness among consumers/beneficiaries, providers and others who may be in a position to report fraud.

Rainmakers’ Solution

Rainmakers Strategic Solutions provided a multi-disciplinary team of health care and fraud experts, (including former law enforcement fraud investigators, medical record reviewers, pharmacists, nurses, and health care policy researchers), and communications and training professionals (graphic artists, communication specialists, a media specialist, event planners, videographers, instructional designers, and website developers) to execute this 5-year endeavor.

We developed and implemented a strategic communications plan to manage multiple concurrently-running campaigns with various messages, target audiences, product types, production schedules and distribution methods. In response to our online surveys, focus groups, and event polling, Rainmakers was able to assess audience needs, understand their level of awareness and obtain feedback on ongoing and upcoming campaigns. This feedback assisted in the development of a visually appealing and compelling, plain language portfolio.

In addition, we developed, maintained, hosted, and eventually rebranded a website which served as a 508-compliant delivery channel for these outreach and education products, an online resource repository, and interactive tools for consumers and professionals.

Rainmakers also planned and facilitated up to 6 in-person and virtual events (webinars and webcasts) and multiple training workshops per year for 175 to 1,200 attendees which consistently achieved 90% or better satisfaction ratings.

• Health Care Fraud Detection
• Predictive Analytics
• Data Analysis
• Claims Review
• Financial Audit
• Compliance Program Development and Review
• Fraud, Waste and Abuse Training

Scenario

Client Challenge

The Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and CHIP Services identified program integrity problems caused by a lack of standardized and complete provider data, no accurate method by which to monitor the same providers in the two programs of Medicare and Medicaid and the lack of an automated method to identify high risk providers. Early data submissions from States participating in the 10-State Provider Enrollment Pilot demonstrated significant inconsistencies in the volume, consistency, and completeness of the data.

As a result, the Provider Enrollment Predictive Model (PEPM) project was initiated and a contractor was engaged to build a predictive model using a subset of T-MSIS data to identify a provider’s likelihood to commit fraud. CMS also sought a contractor to test and evaluate the model.

Rainmakers’ Solution

Rainmakers Strategic Solutions was engaged to evaluate models developed by another contractor. We applied a deep understanding of the Medicare and Medicaid programs and knowledge of provider billing practices and reimbursement policies to review data analysis results and predictive models. In addition, Rainmakers data analysts and provider fraud experts went beyond the initial scope of the project to design a predictive model and risk assessment methodology that led to an estimated $800M in potential Medicare and Medicaid fraud. Our work involved analysis of various data sources, including T-MSIS, Fraud Investigations Database (FID), and OIG’s List of Excluded Individuals/Entities (LEIE).

• Project Management
• Strategic Planning
• Business Requirements Elicitation
• Business Process Improvement
• Program Review/Analysis
• Facilitation
• Risk Management
• Scheduling
• Performance Improvement
• Acquisition Support

“It has been a pleasure working with this contractor team. I sincerely want to thank everyone for their efforts and express my deepest appreciation for their support.”

– VA ESM Program Integration Service Manager

Scenario

Client Challenge

More and more government agencies have recognized the value of professional program management expertise in ensuring on-time delivery of IT projects and safeguarding against the waste of public funds. Government project managers seek contractors that can deliver highly trained consultants with domain knowledge and demonstrated expertise in managing large, complex, high visibility projects.

Rainmakers’ Solution

Rainmakers’ Program Management Professionals (PMPs) have assisted a variety of government clients in managing some of the most complex IT projects today. Our clients have included, the Department of Veterans Affairs, Centers for Medicare & Medicaid Services, and Department of Defense. We provide full-service Program Management Office (PMO) support from the planning through post-implementation stages. Representative project examples include:

1. VA Health Administration Program Enhancement (HAPE) PMO – provide program managers to support the largest ICD-10 implementation in the country, with over 130 complex enhancement projects impacting VA’s clinical and administrative systems at almost 1000 facilities. Solutions included: governance charter, schedule management, risk management, configuration management, meeting support, acquisition support, integrated project team facilitation, business requirements review, financial analysis, and program management review board document preparation.

2. CMS PMO Support – provided business process improvement, integrated project team facilitation, administrative and project management support for the Enterprise Data Group.

3. VA Faster Care Scheduling Pilot/ Prosthetics and Orthotics System – Rainmakers deputy project manager performed a variety of project management duties, including project reporting, scheduling, risk management and meeting facilitation.
CMS Encounter Data Coordination Project – for the Financial Alignment Initiative, developed business requirements and DROOLS engine rules that govern the disaggregation of dual eligible claims containing commingled Medicare and Medicaid benefits into separate Medicare and Medicaid encounter records.

4. Army MEDCOM Laboratory Information Management System (LIMS) – provided project, schedule and risk management for the development and implementation of a LIMS for secure AIDS specimen collection and testing worldwide.

5. VA Concept of Operations (CONOPS) – Rainmakers team developed CONOPS documents in support of VHA stakeholders. CONOPS documents addressed:

• Impact of Caregivers Omnibus Legislation on VHA IT systems
• Preparation of a test package to support the national rollout of approved Clinical Information Systems (CIS) and Anesthesiology Record Keeping (ARK) solutions
• Evaluation of existing automated patient hand-off tools and development of requirements and recommendations to support an automated, multidisciplinary patient hand-off solution
• Preparation of a Business Requirements Document (BRD) for the new WebHR portal
• Development of a deployment strategy and plan to assist with national deployment of the Lab Systems Re-engineering Project (LSRP)

• Compliance reviews
• Performance measurement and evaluation
• Strategic planning
• Health policy research
• Affordable Care Act (ACA)
• Medicare Modernization Act (MMA)
• Health Insurance Portability and Accountability Act (HIPAA)
• Social Security Act

“Excellent Customer Service and Responsiveness to all requests. Rainmakers has contributed innovative solutions, creative alternatives, and provided recommendations that has expanded and focused our conceptual ideas into workable products and executable plans. They are truly a good partner in understanding our organizational needs.”

-Health and Human Services (HHS), Office of Inspector General (OIG)

Scenario

Client Challenge

The Centers for Medicare & Medicaid Services (CMS) required contractor assistance to perform regulatory and compliance oversight of private health plans participating in the Medicare Prescription Drug (Medicare Part D) program. For the protection of Medicare beneficiaries, CMS requires that health plans obtain approval of their prescription drug formularies and utilization management practices annually.

Rainmakers’ Solution

Rainmakers Strategic Solutions’ licensed pharmacists support CMS’ oversight of the Medicare Part D program. We review all Part D plan sponsor prescription drug formularies, utilization management practices and member transition policies to determine compliance with the Medicare Modernization Act and CMS guidelines.

We maintain a database of widely‐accepted treatment guidelines by performing environmental scans and literature reviews to identify new/modified guidelines. Our primary objectives are to ensure that Medicare beneficiaries are protected from discriminatory practices and can access the high-quality health care they deserve.

We apply extensive knowledge of Medicare Part D program requirements benefits, regulations and applicable laws to establish guidelines and review health plans with accuracy and consistency so that our recommendations to CMS are defensible.