Payment Reform

The case for an integrated approach to care—one that can seamlessly and collaboratively address patients’ physical and behavioral health needs—is compelling. Individuals with behavioral health conditions, either a mental health diagnosis, a substance use disorder, or both, are some of the Medicaid’s most costly enrollees.[i] Analyses indicate this subset of high-cost enrollees typically has a […]

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  • Publications

    NASHP recently brought together a group of state and federal policy leaders to discuss the Medicare-Medicaid Financial Alignment Initiative, D-SNP health plans, and other programs and resources aimed at aligning health care payment and delivery to improve care for dual eligibles. See a report from the meeting and sign up for a webinar on state […]

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  • Publications

    Unplanned and complex births carry potentially avoidable health complications and costs to families and states. Broad healthcare payment and delivery reform is underway across the country to improve outcomes, enhance patient experience and reduce costs. Some states are capitalizing on these reforms to promote planned and healthy births by driving improvement in effective contraceptive use […]

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  • 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