Managed Care

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Supporting Technology-Enabled Innovation in Medicaid Managed Care to Improve Quality and Equity: State Considerations

This brief explores design considerations and policy levers Medicaid agencies may consider for encouraging uptake of tech-enabled innovation within Medicaid managed care. The brief is a product of the Medicaid Innovation Collaborative, which brings together Medicaid programs, their managed care plans, and other stakeholders to spread tech innovations that can improve the health of Medicaid populations. The collaborative is led by Acumen America, Adaptation Health, and the Center for Health Care Strategies and supported by The MolinaCares Accord, CommonSpirit Health, and Hopelab.

Short URL: http://www.advancingstates.org/node/74083

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Medicaid: State Directed Payments in Managed Care

When states use a Medicaid managed care delivery system, the contracted managed care organizations (MCOs) generally determine provider payment rates. However, in certain circumstances states may direct payments to providers through the MCOs in accordance with state-set criteria. In this report, GAO describes (1) the use of state directed payments in Medicaid, and (2) CMS's changes to guidance and oversight of these payments.

Short URL: http://www.advancingstates.org/node/74002

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2020 Medicaid Managed Care Enrollment and Program Characteristics

On Monday, June 13, 2022 CMS released the 2020 Medicaid Managed Care Enrollment and Program Characteristics and Data Tables. This national data is broken down by program, population, and individual state. The enrollment data provides a snapshot of Medicaid managed care enrollment as of July 1, 2020.

Short URL: http://www.advancingstates.org/node/73974

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Value-Based Payment in Medicaid Managed Long-Term Services and Supports: A Checklist for States

Medicaid value-based payment (VBP) models tie payment to outcomes including quality of care, health status, and costs. This guide presents a checklist of four issues for consideration as states identify issues to consider when developing and adopting value-based payment (VBP) models for HCBS within managed long-term services and supports (MLTSS) programs. The guide also reviews strategies for stakeholder engagement.

Short URL: http://www.advancingstates.org/node/71057

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States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019

This recently released report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019. The report focuses on changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.

Short URL: http://www.advancingstates.org/node/70859

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Exploring the Growth of Medicaid Managed Care

This report presents information on managed care’s enrollment and spending. It explores the growth of enrollment in Medicaid Managed Care in the United States and the contributing factors. It also analyzes the fact that funding does not directly parallel enrollment, as the share of total Medicaid spending that went to managed care only grew from 15 percent to 37 percent between 1999 and 2012, despite enrollment growing from 63 percent to 89 percent during that same time period.

Short URL: http://www.advancingstates.org/node/70681

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Fundamentals of Community-Based Managed Care: A Field Guide

The Spring 2018 issue of Generations, the quarterly journal of the American Society on Aging, is divided into three main parts. These three sections are building community partnerships, building business practices, and examples of successful CBO use of business acumen. This issue also has a special focus on how the social determinants of health influence the experience of older adults in the community.

Short URL: http://www.advancingstates.org/node/70352

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Managed and Integrated Care Bootcamp: Packaging Your Services: Telling Your Value Story

This interactive session, from n4a’s 2016 annual conference, helped participants learn how to tell their organization’s story and package their “products” in ways that will help them get noticed and appreciated by health care payers. Presenters included representatives from health plans who discussed what they look for in a “pitch” from a community-based organization seeking to market its services.

Short URL: http://www.advancingstates.org/node/69980

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Emerging Innovations in Managed Long-Term Services and Supports for Family Caregivers

This paper provides direct insights from managed care leaders about family caregiver supports and provides examples of how progressive managed care plans are supporting family caregivers who are caring for plan members with LTSS needs. The paper discusses how it is important to understand and address family caregivers’ roles and their needs in order to have a high-performing LTSS system, because the family provides the lion’s share of LTSS to people who need help.

Short URL: http://www.advancingstates.org/node/69915

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