Government

Covalence Health supports federal and state government agencies in developing, implementing, and optimizing programs across Medicare, Medicaid, and specialized initiatives including PACE, LTSS, Rural Health Transformation Programs, and Section 1115 and 1915 waiver programs. Our team understands that government healthcare programs operate at the intersection of policy intent, regulatory compliance, fiscal responsibility, and real-world operational feasibility—and that successful program design requires balancing all four simultaneously. We help agencies translate policy objectives into implementable program structures, ensuring that regulations are not only technically sound but practically enforceable and administratively workable for the providers, health plans, and managed care organizations expected to deliver services. Our approach begins with rigorous medical economics modeling that accounts for utilization patterns, cost trends, risk adjustment, and budget impact across different populations and geographies. We don't just project costs—we stress-test assumptions against historical data, demographic shifts, provider capacity constraints, and behavioral factors to ensure programs are financially sustainable while achieving intended health outcomes for vulnerable and underserved populations.

Program success depends equally on execution as design, and that requires identifying and managing the right implementation partners. Covalence Health helps government agencies navigate vendor selection for managed care organizations, third-party administrators, technology platforms, care coordination providers, and specialty service vendors that will operate critical program components. We understand that government procurement isn't just about lowest cost or best capabilities on paper—it's about regulatory compliance track records, financial stability, cultural competency for specific populations, data security and interoperability standards, and demonstrated ability to meet reporting and accountability requirements. Our experience across Medicare Advantage, Medicaid managed care, value-based care models, and CMMI demonstrations allows us to evaluate partners through the lens of what actually works in regulated environments versus what sounds good in proposals. We support agencies through the entire partnership lifecycle—from RFP development and vendor evaluation through contract negotiation, implementation oversight, and ongoing performance management—ensuring that program goals are achieved and taxpayer dollars are deployed effectively while maintaining the regulatory integrity that government programs require.