Payment Reform

In this webinar, members of the National Academy for State Health Policy’s Pharmacy Costs Workgroup review 11 specific proposals for how states may curb the rising cost of pharmaceuticals. NASHP’s work group looks broadly at states as purchasers, regulators, policymakers, and investors to develop the next generation of state–based reforms to address the rapid growth […]

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  • Publications

    Primary Care Provider Burnout: Implications for States & Strategies for Mitigation

    Provider burnout is widespread and becoming more pervasive over time. Using the experience of the Heart of Virginia Healthcare (HVH) as a lens, this brief addresses the scope and impact of provider burnout, why states should care, and what states can do about it. HVH is one of seven regional cooperatives reaching 1500 primary care practices nationwide as […]

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  • Publications

    Measuring Physical and Behavioral Health Integration: A Look at State Approaches in the Context of Value-Based Purchasing

    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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    January 3, 2017 | Filed under: Front Page, Payment Reform, Publications

  • Publications

    Federal and State Collaboration for Medicare-Medicaid Alignment

    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

    Medicaid Incentives for Effective Contraceptive Use and Postpartum Care

    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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  • State Financing and Delivery Innovations to Address Disparities in Uncontrolled Childhood Asthma

    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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  • Surprise Billing Legislation Passed in 2016

    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

    Managing Medicaid Managed Care: New State Strategies to Promote Accountability and Performance

    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

  • Overview of State Programs that Utilize an Assessment of Self-Funded ERISA Plans and/or Third Party Administrators

    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

    Understanding Medicaid Claims and Encounter Data and Their Use in Payment Reform

    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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