1 / 5

System Reform Efforts in Medicaid

System Reform Efforts in Medicaid. Kathleen Nolan National Assoc. of Medicaid Directors July 15, 2013. State Variability to consider. Tools that are appropriate for your state will differ, depending on a number of qualities, such as: Managed care versus fee-for-service

lawrencia-benedict
Download Presentation

System Reform Efforts in Medicaid

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. System Reform Efforts in Medicaid Kathleen Nolan National Assoc. of Medicaid Directors July 15, 2013

  2. State Variability to consider Tools that are appropriate for your state will differ, depending on a number of qualities, such as: • Managed care versus fee-for-service • Competitive plan selection • Delivery system factors • Covered populations • Health status, utilization patterns, and cost trends.

  3. Why Medicaid can be a leader in delivery system and payment reform • Medicaid is a major purchaser for: • Births and pregnancy, • Disability services, • long-term care, • chronic disease management and prevention: • all of which are topics in delivery system redesign and important opportunities for quality improvement and cost containment.

  4. Payment reform buckets • Targeted payment adjustment policies • Hospital errors or readmission rates result in a payment change. • Managed fee-for-service • Incentivizing care or services practice by practice in FFS environments. • Bundled payments • Single payment for a set of services, usually based on a health condition. • Care management initiatives • Add-on payments for non-clinical services and case management for chronically ill or disabled patients. • Health homes • Enhanced payments for a range of clinical and supportive services for a population.

  5. Payment reform must be joined to quality Payment reforms must include quality monitoring and be connected to improvement in care and outcomes. • Quality metrics must be developed and an oversight plan that will monitor system outcomes • Payment must be tied to these quality outcomes, not just to reducing expenditures. • Need strong data collection systems and analytics to ensure outcomes are achieved and avert unintended consequences.

More Related