Manatt Health: Leveraging Medicaid Managed Care to Advance Value-Based Payment

As healthcare costs continue to rise and stakeholders maintain focus on improving quality of care and outcomes, payors for healthcare services are turning to value-based payment (VBP) as one tool to inject greater value into the delivery of care. Medicaid, the nation's largest health insurer, is no exception. Across the country, state Medicaid agencies are looking to increase provider accountability for cost and quality of care, and many are leveraging their Medicaid managed care programs in new ways toward that end.

Most of the 39 states with comprehensive, risk-based managed care use their contracts with managed care plans to advance payment reforms, increase the proportion of plan payments that are value-based, or enhance the level of risk being assumed by providers.

A Manatt Health review of 39 states' Medicaid managed care contracts and related sources found that 28 states require plans to engage in VBP with network providers; two other states explicitly encourage or otherwise incentivize plans to engage in VBP. Read more here.

Social Determinants of Health Innovation Application Now Available

The New York State Department of Health (DOH), Office of Health Insurance Programs (OHIP), Bureau of Social Determinants of Health, is launching a new initiative to identify innovative ideas to effectively address the Social Determinants of Health (SDH) for Medicaid members across New York State. The intent of this 'Call for SDH Innovations' is to solicit input from interested parties across the state and around the country. Innovations will be reviewed by a team of healthcare experts identified by DOH. Top innovations will receive special recognition but all innovations, with the consent of the submitting organization, will be shared publicly by DOH.  

 

Later this fall, the Department of Health will host a Social Determinants of Health Innovation Summit that will allow the applicants with the best solutions to pitch their product or idea to a panel of expert judges and audience members. While there is no funding from the State available for this initiative, it is a chance for innovative companies and organizations to receive exposure to key healthcare decision makers including, but not limited to, healthcare providers, Managed Care Organizations, and DSRIP Performing Provider Systems.

 

Innovations are due by June 15, 2018 at 5:00 PM. The Call for Social Determinants of Health Innovation application is now available here.

Prioritizing Social Determinants of Health in Medicaid ACO Programs: A Conversation with Two Pioneering States

There is increasing recognition that medical care is only one of several factors affecting health outcomes. In February, a  national CHCS webinar, explored early state approaches for using Medicaid accountable care organizations (ACOs) to address social determinants of health (SDOH) as a way to improve health outcomes and contribute to potential savings. The webinar zeroed in on two state Medicaid ACO programs that prioritize SDOH:  Minnesota's Integrated Health Partnerships (IHPs) and  Rhode Island's Accountable Entities (AEs).

CHCS recently spoke with Mat Spaan, Manager, Care Delivery and Payment Reform, Minnesota Department of Human Services; Deborah Faulkner, President, Faulkner Consulting Group; and Deborah Morales, Senior Consulting Manager, Conduent at Rhode Island Executive Office of Health & Human Services to follow-up on key questions raised during the webinar. Read more here.