The Alignment Of Medicaid Benefits – The Health Plans Have It

Medicaid health plans are moving ahead with the shift to alternate payment methodologies (APM) at a relatively rapid rate. Twenty-two states require health plans to move to value-based reimbursement and eleven states use Medicaid accountable care organizations (see Success Today, Success Tomorrow – Strategy Issues in The Changing California Behavioral Health Market).

Why financial alignment matters is clear. Care coordination and incentives based on ‘total cost of care’ are possible where financial risk is aligned. Setting targets for reduction of total spend is not possible if those funding streams aren’t aligned. In states that do not put behavioral . . .