Payment and Delivery Reform
FEATURED ARTICLE
Updated HHS Guidance on Improving Health Care Access for Justice-Involved Individuals
/in Policy Blogs Behavioral/Mental Health and SUD, Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Health Coverage and Access, Health Equity, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Quality and Measurement, Social Determinants of Health /by Anita CardwellLast Thursday, the Department of Health and Human Services (HHS) released new guidance to clarify and update policies related to how states can improve access to Medicaid coverage and services for incarcerated individuals transitioning back into communities. Based on data from a newly published HHS report, currently 2.2 million individuals are incarcerated and an additional […]
Webinar: A Conversation with State Officials on Medicaid Dental Managed Care
/in Policy Arizona, Kentucky, Pennsylvania Webinars Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Medicaid Managed Care, Oral Health /by NASHP StaffManaged Care for Medicaid Dental Services: Insights from Kentucky
/in Policy Kentucky Reports Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Medicaid Managed Care, Oral Health /by Najeia MentionA growing number of states are administering Medicaid managed care contracts that include both medical and dental services. In 2015, Kentucky identified dental services as one of seven key areas where the state wanted to achieve measurable improvement in its Medicaid managed care contracts. This case study examines the history of dental managed care in […]
Early Highlights of CMS’s Final Managed Care Rule for Medicaid and CHIP
/in Policy Blogs CHIP, CHIP, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Health Coverage and Access, Health System Costs, Healthy Child Development, Maternal, Child, and Adolescent Health, Medicaid Managed Care /by Tamara KramerOn April 25, the Centers for Medicaid and Medicare Services (CMS) released a long-awaited final rule that updates the regulations for managed care organizations in the Medicaid and Children’s Health Insurance Programs (CHIP). These new requirements represent the first major updates to Medicaid and CHIP managed care since 2002. In the intervening years, the percentage […]
Managing Medicaid Managed Care: New State Strategies to Promote Accountability and Performance
/in Policy Ohio, Tennessee Reports Cost, Payment, and Delivery Reform, Health Coverage and Access, Medicaid Expansion, Medicaid Managed Care, Quality and Measurement, State Insurance Marketplaces, Value-Based Purchasing /by Sarabeth Zemel, Alice Weiss and Neva KayeAs the scope of State Medicaid agencies becomes wider and more complex, states are increasingly turning to managed care organizations (MCOs) to cover Medicaid enrollees, including those with complex needs. This shift from a fee-for-service, volume-based payment model requires states to effectively manage MCOs and other vendors. With states facing tight budgets, limited staff, and […]
States and Prescription Drugs: An Overview of State Programs to Rein in Costs
/in Policy Reports Administrative Actions, Cost, Payment, and Delivery Reform, Essential Health Benefits, Health Coverage and Access, Health System Costs, Medicaid Expansion, Medicaid Managed Care, Prescription Drug Pricing, State Rx Legislative Action /by Ellen SchneiterStates are significant purchasers of health care for Medicaid, inmates in correctional facilities, and public employees. Despite considerable efforts to maintain affordability, drug pricing continues to vex state budgets. While Medicaid is the largest single health expenditure in state budgets, spending on health care for public workers including state employees and retirees, legislators, judicial employees, […]
Answering the Thousand-Dollar Debt Question: An Update on State Legislative Activity to Address Surprise Balance Billing
/in Policy Reports Consumer Affordability, Cost, Payment, and Delivery Reform, Health System Costs /by NASHP WritersAs the newly insured use their coverage, increased scrutiny is being drawn toward the experiences of consumers who are receiving care. One issue of growing concern is the accumulation of medical debt, even among the insured. According to a recent study from the Kaiser Family Foundation, more than a quarter of adults in the United […]
Overview of State Programs that Utilize an Assessment of Self-Funded ERISA Plans and/or Third Party Administrators
/in Policy Charts Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Medicaid Managed Care, Quality and Measurement /by NASHP StaffAs described in a recent NASHP blog, the Supreme Court’s decision in Gobeille v Liberty Mutual, which denied the state’s ability to mandate claims submission from self-funded ERISA health plans, may have started us down a slippery slope. In light of this new approach to what state requirements are preempted by ERISA, the Supreme Court asked […]
Are States Losing Key Tools for Health Reform?
/in Policy Michigan, Vermont Blogs Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Quality and Measurement /by Lesa RairEngaged in multi-payer payment reforms? Seeking information about the cost of care? About the rate of opioid prescribing? Assessing carriers to generate needed revenue to support state activities like vaccines for children? You might soon hit a federal stoplight. The Supreme Court’s recent decision in Gobeille v Liberty Mutual, which denied the state’s ability to […]
State Community Health Worker Models
/in Policy Charts Chronic Disease Prevention and Management, Community Health Workers, Cost, Payment, and Delivery Reform, Health System Costs, Population Health /by NASHP StaffClick here to explore the State Community Health Worker Models map and chart.
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