Payment and Delivery Reform
FEATURED ARTICLE
Flurry of Bills Targeting the Opioid Epidemic’s Impact on Families Reach Congress
/in Policy Blogs Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Health Coverage and Access, Health Equity, Healthy Child Development, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement, Safety Net Providers and Rural Health, Social Determinants of Health, Workforce Capacity /by Miara Handler and Carrie HanlonThe country’s opioid crisis has had a devastating effect on women, children, and families, and continues to strain state health, foster care, and social service agency budgets. A flurry of bills has recently been introduced in Congress to prevent or reduce the effects of the opioid crisis and many directly impact families and children. The […]
Feds Send Mixed Responses on States’ Efforts to Control Medicaid Drug Costs
/in Policy Administrative Actions, Cost, Payment, and Delivery Reform, Health System Costs, Prescription Drug Pricing, State Rx Legislative Action /by Chris Kukka and Johanna ButlerThe Centers for Medicare & Medicaid Services (CMS) had a mixed response to two states’ innovative efforts to control Medicaid drug costs in June. The agency denied Massachusetts’ 1115 waiver request to create a closed Medicaid drug formulary, but it approved Oklahoma’s State Plan Amendment that authorizes supplemental rebates for value-based purchasing arrangements with pharmaceutical […]
How State Medicaid and Title V Partnerships Improve Care for Children with Special Health Care Needs in Medicaid Managed Care
/in Policy Behavioral/Mental Health and SUD, Care Coordination, Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Health System Costs, Healthy Child Development, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Hannah Eichner and Kate HonsbergerStates are increasingly utilizing Medicaid managed care (MMC) to serve children and youth with special health care needs (CYSHCN), who often require a complex array of services. Many states are finding that forging partnerships between their MMC systems and Title V CYSHCN programs improves care coordination, transitions from pediatric to adult care systems, quality of […]
NASHP’s State SUD Policy Institute Supports States to Address SUD in Federally Qualified Health Centers
/in Policy Alabama, Illinois, South Dakota, Virginia, Wisconsin Blogs Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Integrated for Pregnant/Parenting Women, Maternal, Child, and Adolescent Health, Population Health, Primary Care/Patient-Centered/Health Home, Safety Net Providers and Rural Health /by NASHP WritersNASHP congratulates the five states selected to participate in NASHP’s State Substance Use Disorder (SUD) Policy Institute: Alabama Illinois South Dakota Virginia Wisconsin The State SUD Policy Institute, supported by a cooperative agreement with the Health Resources and Services Administration, will assist these five state teams to develop innovative strategies to increase access to and […]
Washington’s Medicaid Chief Examines the Future of Medicaid and Health Reforms
/in Policy Washington Blogs Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Essential Health Benefits, Health Coverage and Access, Health System Costs, Medicaid Expansion, Medicaid Managed Care, Population Health, Quality and Measurement, State Insurance Marketplaces, Value-Based Purchasing /by NASHP WritersMaryAnne Lindeblad oversees Washington State’s Apple Health (Medicaid) program, which serves more than 1.8 million residents. She also chairs the National Academy for State Health Policy’s executive committee and is a National Association of Medicaid Directors board member. Lindeblad took time recently to talk to NASHP about the future of Medicaid and health care reform. […]
State Strategies to Advance Medical Homes for Children and Youth with Special Health Care Needs
/in Policy Behavioral/Mental Health and SUD, Care Coordination, Children/Youth with Special Health Care Needs, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Healthy Child Development, Integrated Care for Children, Maternal, Child, and Adolescent Health, Physical and Behavioral Health Integration, Population Health, Primary Care/Patient-Centered/Health Home /by NASHP StaffMedical homes are critical components of comprehensive care systems for children and youth with special health needs (CYSHCN). They can reduce costs and improve outcomes and care experiences for CYSHCN and their families. This new report, State Strategies to Advance Medical Homes for Children and Youth with Special Health Care Needs, examines effective strategies used […]
A Glossary of All Terms Pharma
/in Policy Administrative Actions, Cost, Payment, and Delivery Reform, Health System Costs, Prescription Drug Pricing, State Rx Legislative Action /by Chris Kukka and Jane HorvathIf you’re working to control the cost of prescription drugs, you need to know the lingo used by the pharmaceutical industry. Below is a glossary of terms commonly used by players in the drug research, regulation, manufacturing, distribution, and purchasing worlds. Drug Product Terms Brand product: Branded products are not generic drugs or products. A brand can be […]
How States Can Improve Access to Care for Children Under the Medicaid Managed Care Rule
/in Policy Colorado, Virginia Blogs Behavioral/Mental Health and SUD, Care Coordination, Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Health System Costs, Healthy Child Development, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Kate HonsbergerNext month, states face new federal requirements for establishing and maintaining Medicaid managed care provider networks. As they work to comply with these new rules, states have an opportunity to strengthen access to care for children and youth with special health care needs (CYSHCN). Medicaid and requirements, which address how enrollees access care and the […]
An Early Look at Vermont’s Value-Based, Multi-Payer “Next Gen” Model, Designed to Lower Costs and Improve Population Health
/in Policy Vermont Reports Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Medicaid Expansion, Medicaid Managed Care, Population Health, Quality and Measurement, State Insurance Marketplaces, Total Cost of Care Benchmark, Value-Based Purchasing /by NASHP WritersBy Robin Lunge, JD, MHCDS Robin Lunge is a member of Vermont’s Green Mountain Care Board, which regulates health insurance rates, hospital budgets, and accountable care organizations. In this brief, she explores how the state’s transformation from a fee-for-service payment system to a value-based, multi-payer model designed to curb health care spending and improve care […]
The Roadmap Ahead: New York’s Value-Based Payments Reward Communities and Providers for Addressing the Social Determinants of Health
/in Policy New York Blogs Accountable Health, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Medicaid Expansion, Medicaid Managed Care, Population Health, Quality and Measurement, Social Determinants of Health, State Insurance Marketplaces, Value-Based Purchasing /by Amy ClaryMedicaid payment models in many states are shifting away from rewarding providers for the quantity of care they provide to models that reward high-quality, coordinated care that addresses some of the broader social factors that influence health and well-being. One example is New York’s Value-Based Payment (VBP) Roadmap, which rewards Medicaid providers and community-based organizations […]
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
State Delivery System and Payment Reform Map
/in Policy Maps Care Coordination, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health System Costs, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Primary Care/Patient-Centered/Health Home, Quality and Measurement, Value-Based Purchasing Cost, Payment, and Delivery Reform /by NASHP