- Are you ready for New York State Medicaid value-based payment models?
By Brett Friedman, Rebecca L. Johnson, Howard Kahn | 08 November 2018
This paper provides a high-level overview of the New York State value-based payment models, discusses the opportunities and challenges for providers considering participation in them, and highlights the needs for sophisticated actuarial, financial, and legal expertise to address the inherent business, legal, and operational risks.
- Approved Medicaid state directed payments: How states are using §438.6(c) Preprints to respond to the managed care final rule
By Jim B. Pettersson, Ben Mori, Luke B.G. Roth, Jason A. Clarkson | 30 October 2018
This paper provides a background on state directed payment arrangements based on our review of §438.6(c) “Preprints” and supporting documentation for arrangements approved by the Centers for Medicare and Medicaid Services as of August 15, 2018.
- Medicaid managed care financial results for 2017
By Jeremy D. Palmer, Christopher T. Pettit, Ian M. McCulla | 04 June 2018
This report summarizes the calendar year 2017 experience for selected financial metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.
- Medicaid buy-in: Section 1332 Innovation Waivers, state options, and top ten considerations
By Paul R. Houchens, Christine M. Mytelka, Susan Philip | 11 May 2018
Medicaid buy-ins are currently getting states’ attention.
- How changing opioid prescribing patterns can impact risk scores
By Christine M. Mytelka, Melanie K. Kuester, Colin R. Gray, Lucas Everheart | 19 April 2018
This brief provides data on the decline in opioids prescribed to Medicaid expansion populations and the increased use of other non-opioid pain relief drugs.
- Enabling sustainable investment in social interventions: A review of Medicaid managed care rate-setting tools
By Deborah Bachrach, Jocelyn Guyer, Sarah Meier, John D. Meerschaert, Shelly S. Brandel | 06 February 2018
This report identifies practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues.
- Risk adjustment in CMS episode-based payment models: A resource guide
By Samuel Bennett, Thomas D. Snook | 20 December 2017
This paper provides a high-level guide on risk adjustment within the broader scope of four Centers for Medicare and Medicaid Services episode-based payment models.
- Telehealth under alternative payment models
By Susan Philip | 13 September 2017
Telehealth has the potential to boost the impact of population health management initiatives while improving access and convenience of healthcare delivery.
- Medicaid risk-based managed care: Analysis of financial results for 2016
By Jeremy D. Palmer, Christopher T. Pettit | 07 July 2017
This report summarizes the calendar year 2016 experience for selected financial metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.
- Medicaid risk-based managed care: Analysis of administrative costs for 2016
By Jeremy D. Palmer, Christopher T. Pettit, Ian M. McCulla | 07 July 2017
This report summarizes the calendar year 2016 experience for selected administrative metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.