Managed Care & Value-Based Reimbursement

The impending shift to value-based reimbursement (VBR) and managed care in the health and human services industry has become a driving force across both public and private sector organizations, not only forcing new operating models and systems, but pushing providers to develop new partnerships with payers and to prepare for population health management. This shift presents organizational, technical, and cultural challenges that require a robust technology infrastructure, data-driven decisionmaking, and new leadership competencies. As behavioral health provider organizations move towards risk-based contracts, those who adapt to this change will have a better opportunity to carry forward in the provision of value-based services.

Latest Resources

• The Medicaid Question
• Measuring Outcomes In Whole Person Care
• Another Step Forward
• Amerigroup DC Launches Medicaid Value-Based Agreement With DC Connected Care Network
• InHome Connect’s Data-Driven Palliative Care Model Reduced Hospitalization Rates By More Than 50%
• The Health Plan Imperative
• AMGA & Wilmington Health Launch AMGA Value Care Network To Advance Value-Based Care Nationwide
• AbsoluteCare & Aetna Better Health® Of Illinois Launch Comprehensive Value-Based Health Care Services In Chicago
• Aetna Health Plan – Winning Proposal For Dual Eligible Special Needs Plan (D-SNP) Services To Illinois Department Of Healthcare & Family Services, 2025
• Molina Healthcare Of Illinois – Winning Proposal For Dual Eligible Special Needs Plan (D-SNP) Services To Illinois Department Of Healthcare & Family Services, 2025
• Meridian Health Plan of Illinois, Inc. – Winning Proposal For Dual Eligible Special Needs Plan (D-SNP) Services To Illinois Department Of Healthcare & Family Services, 2025
• Three California Health Plans Unite On Multi-Plan Value-Based Health Care
• Molina Healthcare Of Wisconsin, Inc. – Winning Contract (Family Care Partnership) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Independent Care Health Plan (iCare) – Winning Contract (Family Care Partnership) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Inclusa, Inc. – Winning Contract (Family Care) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025

Rhode Island Cancels Upcoming Medicaid MCO Awards, Extends Current Contracts

The Rhode Island Executive Office of Health and Human Services (EOHHS) canceled awards for its Medicaid managed care organization (MCO) rebid, and extended contracts with the current contract holders: Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans Inc. (Tufts), and UnitedHealthcare of New England Inc. The upcoming contracts were valued at $15.5 billion. No target reprocurement date has been announced. A state spokesperson said the state canceled the contracts because it cannot meet… Read

• Molina Healthcare Of Wisconsin, Inc. – Winning Contract (Family Care) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Lakeland Care, Inc. – Winning Contract (Family Care) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Aledade Expands Humana Value-Based Care Agreement To Serve FQHCs & Rural Health Clinics
• Advancing Measurement-Based Care In School Mental Health
• Community Care Health Plan, Inc. – Winning Contract (Family Care Partnership) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025

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