CERTIFICATIONS
WHO WE ARE
Rainmakers Strategic Solutions LLC
DUNS No. 828-429808
Rainmakers Strategic Solutions LLC (Rainmakers) is a certified 8(a), economically disadvantaged woman-owned small consulting firm, founded in 2007 to provide expertise and highly practical solutions in support of the government and commercial sectors. Rainmakers’ principals are respected professionals with demonstrated success for clients facing evolving requirements and constituent needs. We develop, implement, and improve programs by applying insightful methodologies and delivering innovative results that address and simplify complex issues, streamline processes, and reduce costs.
We have a genuine focus on achieving and maintaining an impeccable business relationship with our customers and supporting them in their efforts to improve processes. Client satisfaction is our most valuable asset and exceeding our customers’ expectations is our primary goal.
Our Services
- Event Planning
- Stakeholder Engagement
- Program Integrity
- Program Management
- Evaluations & Analysis
CORPORATE CHARACTER
Our Mission
To deliver value-added consulting services that enable our clients to envision, implement and measure achievement of their transformational and strategic goals.
- Excellence – Quality in our work is absolutely essential. Client Satisfaction is our priority.
- Passion – Dedication and Commitment to meeting our clients’ needs.
- Diversity – Harnessing and promoting a variety of perspectives to maximize impact.
- Knowledge – Thought leadership, strategic support, and innovation to enable transformation with accelerated speed and enhanced quality.
Our Philosophy
At Rainmakers Strategic Solutions, we strive to provide our customers with a diverse team of experts from various industries, with a passion for knowledge and an unquenchable desire for excellence.
OUR SERVICES
Evaluations & Analysis
- Compliance reviews
- Drug Formulary & Benefits Review
- 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.
Program Integrity
- 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) .
Stakeholder Engagement
Event Planning
Healthcare Quality Measures Development
- Public Reporting
- Persons & Family Engagement
- Technical Expert Panel Support
Program Management
WORK WITH US
Pricing List
Effective January 1, 2020
Labor Category
Partner/Principal
Program Manager
Senior Associate
Associate
Senior Consultant
Consultant
Business/Research Analyst
Functional Specialist
Senior Facilitator
Senior Acquisition Specialist
Subject Matter Expert
Graphics Artist
Administrative Specialist
Rate
$425.00
$325.00
$300.00
$275.00
$250.00
$225.00
$200.00
$300.00
$300.00
$275.00
$495.00
$150.00
$70.00
Prime Contract Vehicles
- GSA Professional Services Schedule – Contract No. GS-10F-053BA
- CMS Measures & Instrument Development and Support (MIDS)
- NIH CIO SP3 – Contract No. HHSN316201800048W (Contract Teaming Arrangement with IdealSystems Solutions)
- CDC Division of Health Quality Promotion (DHQP) Conference Training & Consulting Support BPA (Contract/Task Order Nos. GS-10F-053BA/ 75D30119A03829
Subcontract Vehicles
- SAMHSA IDIQ (subcontractor to JBS International, Inc.)
- VA Agile Delivery of VA Imminent Strategic and Operational Requirements (ADVISOR)
- CMS Research, Measurement, Assessment, Design and Analysis (RMADA)
- CMS Strategic Partners Acquisition Readiness Contract (SPARC)
- VA Transformation Twenty-One Total Technology Next Generation (T4NG)
- HRSA Advisory Committee Meeting Logistical Support Services (AMLSS) BPA (subcontractor to GEARS, Inc.)
NAICS Codes
3545 Ellicott Mills Drive
Ellicott City, MD 21043
Phone No. (443) 348-8067
Fax No. (410) 246-2839
Phoenix, AZ
18444 N 25th Ave, Suite 420
Phoenix, AZ 85023