Quality and Measurement
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 […]
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 […]
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 […]
Understanding Medicaid Claims and Encounter Data and their Use in Payment Reform
/in Policy Reports Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Medicaid Managed Care, Quality and Measurement /by NASHP WritersStates across the country are fully engaged in delivery system and payment reform efforts to improve care and lower costs in their Medicaid programs. Data is a critical component of these efforts. This NASHP brief provides an introduction to two types of Medicaid utilization data—fee-for-service claims data and managed care encounter data—and, based on examples […]
All Eyes on Michigan: Will Assessments on All Health Plans Survive
/in Policy Michigan Blogs Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Quality and Measurement /by Lesa Rair and Tamara KramerOn Monday, the United States Supreme Court sent back a Michigan case for a new finding that could forbid state assessments on self funded plans. The Supreme Court told the Sixth Circuit to reconsider its ruling that a Michigan health insurance tax was not preempted by the Employee Retirement Income Security Act (ERISA) in light of the Supreme Court’s decision […]
Value-Based Payment Reform Academy – Frequently Asked Questions
/in Policy Cost, Payment, and Delivery Reform, Medicaid Managed Care, Quality and Measurement, Value-Based Purchasing /by NASHP StaffTechnical Assistance How many hours of technical assistance can a state receive? NASHP does not place restrictions on technical assistance. In addition to the individual monthly calls for each state team, each team will have ongoing access to NASHP staff who can provide technical assistance or connect states with external faculty in response to state […]
Massachusetts Becomes First State to Pass Statewide Cap on First-Time Opioid Prescriptions
/in Policy Massachusetts Blogs Behavioral/Mental Health and SUD, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health System Costs, Medicaid Managed Care, Quality and Measurement /by NASHP WritersEarlier this year, Massachusetts Governor Charlie Baker discussed his state’s opioid epidemic during his State of the Commonwealth Address. Less than two months later, on March 14, he signed omnibus legislation designed to tackle the epidemic head-on. Chapter 52 of the Acts of 2016 contains a wide range of provisions, however one specific provision is […]
Gobeille v. Liberty Mutual: Decision
/in Policy Blogs Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Quality and Measurement /by NASHP WritersIn a 6-2 decision released today, the U.S. Supreme Court has dealt a blow to state all- payer claims databases. By upholding a lower court’s decision, the Court ruled that states may no longer require self funded plans to submit claims data – that action is preempted by ERISA. In its decision in Gobeille v. Liberty […]
Braiding and Blending Funding Streams to Meet the Health-Related Social Needs of Low-Income Persons: Considerations for State Health Policymakers
/in Policy Reports Behavioral/Mental Health and SUD, Blending and Braiding Funding, Care Coordination, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health Equity, Health System Costs, Medicaid Managed Care, Population Health, Quality and Measurement /by Lesa RairMedicaid beneficiaries often need support outside the scope of clinical health care in order to lead healthy lives, and states are uniquely poised to provide this support by addressing the social determinants of health. While states steward a variety of funding sources that address the needs of low-income populations, too often a Medicaid beneficiary must […]
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. 
Hospital Transparency: State Efforts Reveal More Comprehensive Financial Data than Current Federal Requirements
/in Health System Costs Blogs, Featured News Home Consumer Affordability, Cost, Payment, and Delivery Reform, Health System Costs, Hospital/Health System Oversight, Making the Case for Action, Quality and Measurement, Value-Based Purchasing /by Amanda Attiya and Maureen Hensley-QuinnFederal efforts to increase hospital price transparency are falling short as hospitals fail to fully comply with requirements. However, states with transparency laws that give them access to comprehensive hospital financial data are using the pricing information to more fully analyze hospitals’ fiscal health and inform states’ cost containment efforts.