Advancing Access to Care Through Strategic Medicaid 1115 Waiver Implementation
1. The Engagement Request
As part of Massachusetts' MassHealth Medicaid 1115 Waiver initiatives, a healthcare organization sought to expand access to care while aligning internal operations with broader system-level growth objectives. The waiver provided an opportunity to enhance care delivery, integrate services, and improve outcomes for underserved populations. However, tracking progress, ensuring compliance, and optimizing program implementation across multiple stakeholders required a strategic, coordinated approach.
2. The Solutions
To align internal and system-wide efforts with the objectives of the 1115 Waiver, we conducted a structured program evaluation and developed an implementation framework to track, refine, and scale initiatives effectively.
Program Tracking & Performance Assessment
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Developed key performance indicators (KPIs) to measure progress on care expansion, cost efficiency, and patient engagement.
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Conducted data analysis and reporting to monitor program effectiveness and identify areas for improvement.
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Established a structured tracking system to align waiver initiatives with internal growth and external compliance requirements.
Strategic Program Implementation
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Worked cross-functionally with clinical, operational, and administrative teams to streamline waiver-related program execution.
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Identified best practices for scaling services, ensuring sustainability while expanding access to underserved populations.
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Created standardized workflows to enhance care coordination and optimize provider participation in the program.
System-Level Integration & Growth Alignment
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Collaborated with state agencies, payors, and partner organizations to align efforts with broader Medicaid transformation goals.
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Provided strategic recommendations to leadership on how to leverage the waiver for long-term financial and operational sustainability.
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Developed a roadmap for continued program evolution, ensuring that future growth remained aligned with regulatory frameworks and funding opportunities.
3. The Processes
Both frameworks provide an execution-first approach that resonates with problem-solving methodology:
✔ Kotter’s Change Model focuses on strategic alignment and stakeholder engagement, ensuring Medicaid transformation is not just implemented, but institutionalized.
✔ Lean Six Sigma applies data-driven process optimization to Medicaid waiver initiatives, maximizing impact through measurable efficiencies.
Kotter's 8-Step Change Model: Driving Medicaid Waiver Transformation At Scale
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Executives understand that large-scale healthcare transformations require more than policy shifts—they demand structured change management to drive adoption, mitigate resistance, and create lasting impact. Kotter’s framework provides a proven roadmap to position Medicaid 1115 waiver initiatives for success within a complex payer-provider ecosystem.
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Application to Medicaid 1115 Waiver Strategy:
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Create a Sense of Urgency: Conduct stakeholder interviews and data analysis to quantify access gaps and financial inefficiencies, making the case for immediate action.
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Build a Guiding Coalition: Establish a cross-functional leadership task force—including payer executives, health system administrators, and policy experts—to champion implementation.
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Develop a Vision & Strategy: Define a structured execution roadmap that aligns waiver goals with long-term cost containment and value-based care initiatives.
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Communicate the Change Vision: Deploy targeted messaging across stakeholder groups (e.g., provider networks, government agencies) to drive buy-in and alignment.
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Empower Broad-Based Action: Identify and remove operational bottlenecks, integrating waiver initiatives into existing provider workflows and reimbursement structures.
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Generate Short-Term Wins: Track early success metrics (e.g., reduced ER utilization, improved provider participation) to reinforce commitment.
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Sustain Acceleration: Leverage best practices from high-performing regions to refine and scale implementation across the state.
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Anchor New Approaches in Culture: Embed Medicaid waiver strategies into long-term policy, reimbursement models, and provider incentive structures to ensure sustained impact.
Why It’s Effective:
Kotter’s model offers a structured framework to align stakeholders, accelerate execution, and create systemic change without disrupting care delivery.
Lean Six Sigma (LSS): Optimizing Medicaid Waiver Implementation for Maximum ROI
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Why It Matters:
At an MBB firm, engagements must go beyond compliance—clients expect Medicaid waiver implementation to be optimized for efficiency, scalability, and financial sustainability. LSS provides the analytical rigor to deconstruct operational inefficiencies and drive measurable improvements in cost and quality.
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Application to Medicaid 1115 Waiver Strategy:
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Define: Conduct an opportunity assessment to identify Medicaid waiver impact areas, such as reducing avoidable hospitalizations or improving care coordination for high-risk populations.
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Measure: Establish baseline performance metrics using claims data, patient access trends, and provider network participation rates.
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Analyze: Utilize root cause analysis (e.g., process mapping, regression analysis) to pinpoint inefficiencies in program execution, reimbursement cycles, and care delivery workflows.
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Improve: Implement data-driven interventions—such as automated eligibility verification, streamlined provider credentialing, or digital care coordination tools—to reduce administrative burden and enhance service delivery.
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Control: Develop ongoing monitoring systems with real-time dashboards to track performance against key waiver objectives, ensuring continued ROI.
Why It’s Effective:
LSS allows MBB consultants to position Medicaid 1115 waiver implementation as a financial and operational optimization exercise, ensuring measurable impact on cost savings, patient outcomes, and long-term system sustainability.
4. The Results
Established a data-driven framework for tracking and refining waiver-related initiatives, ensuring measurable progress in expanding care access.
Improved program alignment across internal teams and system partners, leading to more efficient implementation and resource utilization.
Positioned the organization for long-term Medicaid funding success by integrating waiver initiatives into a scalable growth strategy
Strengthened care coordination, enabling enhanced service delivery for historically underserved populations.
5. The Key Takeaways
By taking a structured, data-driven approach, the organization successfully leveraged the MassHealth Medicaid 1115 Waiver to expand access to care, optimize program implementation, and drive system-wide growth