Payment Reform

The high prevalence of uncontrolled asthma among child populations served by Medicaid programs and the associated rising costs often are the impetus for states to improve the quality of care provided to children with asthma. New opportunities to comprehensively address asthma and its triggers are emerging through state and national health care delivery system and […]

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  • As health care costs and consumer out-of-pocket expenses continue to rise, states are paying increasing attention to strategies that address consumer concerns. One issue of focus is the practice of balance or “surprise billing,” the process by which patients receive higher than expected bills from providers, often the result of receiving care out-of-network. In April […]

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  • Publications

    As 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 […]

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    April 19, 2016 | Filed under: Front Page, Medicaid, Ohio, Payment Reform, Publications, Tennessee
  • As 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 […]

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    April 6, 2016 | Filed under: Charts, Payment Reform, State Refor(u)m
  • Publications

    States 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 […]

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  • Technical 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 […]

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    March 15, 2016 | Filed under: Payment Reform
  • Congratulations to the six states selected to participate in the NASHP Value-Based Payment Reform Academy: Colorado Hawaii Michigan Nevada Oklahoma Washington, DC NASHP is pleased to announce it is convening a Value-Based Payment Reform Academy. The goal of this academy is for selected states to develop and implement value-based alternative payment methodologies (APMs) for federally […]

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    February 29, 2016 | Filed under: Front Page, Payment Reform
  • State Health Policy Blog

    Self-insured employer participation in multi-payer payment reform is critical for providers to receive consistent messages across payers—an important step toward fostering widespread improvement. A recent study echoes the experience of many state-led multi-payer initiatives experiencing difficulty in engaging self-insured employers. This study looked at reforms in four states: Arkansas, Oregon, Minnesota, Vermont. Only two, Arkansas […]

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    February 19, 2016 | Filed under: Arkansas, Front Page, Payment Reform, State Health Policy Blog
  • State Health Policy Blog

    We recently published a brief on efforts underway in Maryland, Massachusetts, and Vermont to develop and implement global budgeting. Last week, Vermont took the next step, releasing an overview of its proposal to the Centers for Medicare & Medicaid Services (CMS) for an all-payer model. Vermont’s approach distinguishes itself by setting spending targets for almost […]

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    February 2, 2016 | Filed under: Front Page, Payment Reform, State Health Policy Blog, Vermont
  • Publications

    In the five years since the passage of the Affordable Care Act (ACA), 17 states and the District of Columbia have created health insurance exchanges and 30 states and the District have expanded their Medicaid programs to cover low-income populations.  More than 16 million people are newly insured under the law. In addition to expanding health coverage, […]

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