United States

Health and Human Services

KPMG leverages a global network of highly-experienced professionals from across a wide range of functional service areas to deliver thought leadership on topics such as modernizing service delivery models, harnessing data and analytics, improving program outcomes, preventing fraud, and implementing public-private partnerships among other federal, state, and local government health and human services topics. Our professionals leverage their experience in integrated eligibility, Medicaid, child support enforcement, child welfare, technology innovation, WIC, and unemployment insurance to provide unique perspectives that address the challenges governments face now and in the future.

Browse our insights below and contact hhs@kpmg.com with questions or to join our mailing list.

Proposed rule on the health insurance marketplace stabilization: What it means for government entities
This issue brief summarizes the proposed rule by the Centers for Medicare and Medicaid Services that aims to stabilize the health insurance marketplace and describes the potential implications for federal and state entities.
President Trump’s Executive Order on the Affordable Care Act: What it means for government entities
This issue brief provides a short summary of Executive Order 13765, signed by President Trump during his first day in office, to “minimize the economic burden” of the ACA pending its repeal. Also, this issue brief provides actions for federal and state agencies to consider over the next few months.
Profiles of the new administration: Seema Verma and state Medicaid expansion demonstration waivers
This research brief profiles Seema Verma, nominee for Administrator of the Centers for Medicare & Medicaid Services, and provides a summary of the Medicaid waiver proposals in which she has been involved.
Might a 2016 proposal become 2017’s healthcare reform framework?
This issue brief summarizes the healthcare components of Speaker Paul Ryan's plan, "A Better Way: Our Vision for a Confident America", analyzes the potential impact to states and the federal government, and provides recommended steps that government agencies can start taking now to prepare for expected changes.
What is, and is not, possible with repeal of the Affordable Care Act?
Answers to five key questions facing government entities.
Three building blocks for a financially viable health insurance marketplace
Three priority issues that marketplace leaders should consider as they balance the requirements for lean and efficient operations, against the demands of a highly variable and complex health insurance market.
Migrating From the Federally Facilitated to a State-Based Marketplace
How states can move from the Federally Facilitated Marketplace to a State-Based Marketplace to comply with the ACA and the opportunities for federal funds to modernize existing state-level health and human services legacy systems.
The Market Model for Sustainable ACA State Exchanges
Summary of federal regulations relating to ACA financial sustainability and potential state-based exchange financial sustainability operating models.
Enhancing client and case management
The second paper in KPMG's health and human services integrated services delivery series focuses on integrated client and case management, highlighting the opportunities that states have to implement foundational business processes and technology enablers that achieve administrative efficiencies as well as support improved client outcomes.
Digitizing Human Services: Field notes and forecasts from the front lines of government's technological transformation
Forbes Insights and KPMG research report containing interviews with senior executives and case studies on the public sector's digital transformation efforts.
Federal Regulatory Proposals Could Spur Next Generation of Child Welfare Information Systems
Summary of the Notice of Proposed Rule Making for Comprehensive Child Welfare Information Systems (CCWIS) and the implications for state and local child welfare agencies.
Finding the "right doors" for your clients
Highlights the critical ways states can unlock the power of delivery channels to enhance client self-service, improve customer experiences, drive clients towards the “right door” that benefits them, and realign costs to worker-based activities that will improve client outcomes.
Data Sharing Standards Poised to Change Child Support Enforcement
Summary of the affect new legal requirements for data sharing are expected to have on state child support enforcement programs.
Extension to OMB Circular A-87 Cost Allocation Exception Deadline Provides States with More Opportunities to Enhance HHS Eligibility Systems
Key considerations for states to take advantage of the permanent enhanced funding provided for modernizing Medicaid eligibility and enrollment systems and the three-year extension granted by CMS.
Accelerating healthcare policy outcomes
This white paper explores how to bridge the gap between policy design and implementation by following a set of guiding principles gained through various case studies that utilize structured Rapid Cycle Continuous Improvement programs targeting process improvements by frontline healthcare professionals.
The Importance of Governance with Incremental Modernization
This article, originally appearing in the February 2017 edition of APHSA's Policy and Practice magazine, describes five critical elements for governing incremental modernization projects in government health and human services.
The path to value: Early lessons learned
This issue brief discusses leading healthcare transformation practices and early lessons learned for how states can embark on their payment reform journeys in collaboration with major stakeholders.
Funding transformation
As momentum builds for healthcare system reform nationwide, this issue brief discusses states' critical first step of planning a financing strategy for Medicaid transformation waivers.
Life After the Big Bang: Exploring Modular, Agile Paths Toward Health and Human Services Modernization
Research report on how states are modernizing HHS systems through modular, agile procurement.
Planning for an Incremental Approach to Modernization
Outlines a four-step planning process for agencies seeking to adopt a more incremental and agile approach to modernization and systems development.
Redefining the healthcare delivery system: The role of social services
Explores the innovative approaches that governments are taking to integrate social services into healthcare delivery systems.
The Secret to Achieving Meaningful Medicaid Transformation
Important steps that can help a state plan for and achieve meaningful and sustainable Medicaid transformation.
Creating lasting change: A state-level approach to healthcare delivery system reform efforts
Describes how New York State has embarked on one of the nation’s biggest and boldest efforts to move the needle on healthcare outcomes and create a financially sustainable healthcare safety-net system.
A Model for Healthcare Transformation: Delivery System Reform Incentive Payments Program
Highlights states' delivery system transformation and payment reform efforts to improve quality of care, improve population health, and reduce costs, creating the healthcare system of tomorrow.
Developing an Adaptable and Sustainable All Payer Database (APD)
States can use an APD to support healthcare cost savings and quality outcomes. This white paper describes next steps for states to consider in moving to an APD solution.
Value-based purchasing strategies for state employees
Four strategies that states can use to increase value by obtaining higher-quality care at more affordable prices for their covered populations.
A breakdown of new policy guidance for states: Work/community engagement requirements for Medicaid
This issue brief summarizes and puts into context the work/community engagement guidance provided by CMS in the Guidance Letter and briefly outlines key work/community engagement features of Kentucky’s approved demonstration program.
Medicaid Eligibility and Enrollment Toolkit
An overview of MEET, the difference between the Medicaid Enterprise Certification Toolkit and MEET, and suggested next steps for states to achieve compliance.
How Recent Guidance Impacts State Child Support Enforcement Programs
A summary of the final rule for significant technological and programmatic updates to state-administered child support enforcement program operations and considerations for states when assessing the impact of these changes to their child support system modernization plans and operations.
The changing face of Medicaid certification
A summary of CMS's Medicaid Enterprise Certification Toolkit version 2.0 and version 2.1.
Updating Medicaid managed care: A new CMS rule for quality, transparency, and integrity
A summary of CMS's landmark regulation governing Medicaid and CHIP managed care programs and its implications for state Medicaid programs.
Protecting beneficiaries' identities
An overview of the mandate requiring states to replace the Medicare Health Insurance Claim Number (HICN) and considerations for Medicaid agencies.
Federal CCWIS final rule spurs next generation of child welfare information systems
An overview of the final rule and potential opportunities and next steps for state and local child welfare agencies.
Sharing data for better healthcare
How new federal guidance promotes the expansion of health information exchange (HIE) and gives states a new funding tool to encourage connectivity with more Medicaid providers.
A new reporting rule for SNAP
How states must comply with the Department of Agriculture's Food and Nutrition Service's final rule related to reporting changes to SNAP.
The state of oversight and program integrity in managed care
This issue brief discusses three key components of managed care oversight and program integrity, including MCO monitoring and regulatory framework, fraud, waste, and abuse and improper payments in a managed care context, and the role of intelligent automation in managed care oversight and program integrity.
High-Performing State Medicaid Integrity Programs: Putting it all Together in "the Final Mile"
Key challenges and leading practices used by states in addressing the risk of improper payments in Medicaid and provides perspectives on the leading practices in Medicaid integrity programs.
The Affordable Care Act – Financial Managers, Are You Part of the Program Integrity Playbook?
How financial managers at all levels of government have a huge opportunity to bring their knowledge, skills, and abilities to bear in helping program managers implement the Affordable Care Act’s program-integrity provisions.
The opioid epidemic: Spotlighting international efforts to address the crisis
While approximately 80 percent of the global supply of opioids is consumed in the United States, other countries are struggling to control an opioid epidemic. This issue brief discusses strategies deployed in other countries and, where available, a reflection of the results achieved to date.
The opioid epidemic: Data-driven case studies
Despite the struggle to effectively combat the opioid epidemic, a number of efforts have yielded initial positive results and have uncovered promising strategies to attack the multifaceted epidemic through data-driven solutions. This issue brief explores strategies deployed in Rhode Island, Massachusetts, Pennsylvania, and Oklahoma.
The opioid epidemic: A framework for action
This issue brief provides an overview of the crisis, four action areas of the solution framework, and considerations for state and local agencies as they seek to address the opioid epidemic.

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Contact Paul Hencoski
Paul Hencoski

U.S. Lead Partner - Health and Human Services
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