OPEN MINDS Releases Results Of National Survey Of State Medicaid Health Plan Contracts
Recent report provides a state-by-state analysis of Medicaid MCO requirements for provider alternative payment reimbursement
Gettysburg, Pa. (December 11, 2016) — Organizations have recently begun exploring the likely effects of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on not only Medicare, but the health care system as a whole. OPEN MINDS experts have explored this area and agree MACRA demonstrates that paying for value is an evolution in the making. To provide readers with further details and an in-depth analysis of the Medicaid managed care organization (MCO) requirements, OPEN MINDS Market Intelligence Team released the market intelligence report, “State-By-State Analysis Of Medicaid MCO Requirements For Provider Alternative Payment Reimbursement.”
In the report, the OPEN MINDS team reviewed alternative payment methodologies (APMs) and details on MCOs in each state. APMs is an umbrella term used to describe payment models that focus on quality, cost of care, or both rather than utilizing pay-for-volume or fee-for-service payment models. APM are used across all payers—Medicare, Medicaid, and commercial—in different ways and at different levels. The report looks at the use of APMs in state Medicaid programs, specifically which states require MCOs to use APMs for reimbursement to provider organizations. The report outlines whether the state has capitated, at-risk MCOs; whether APMs are included in the MCO’s contract; the specific requirements; and how states define APMs.
The OPEN MINDS Market Intelligence Report, “State-By-State Analysis Of Medicaid MCO Requirements For Provider Alternative Payment Reimbursement,” provides a detailed breakdown and analysis of each state’s Medicaid MCO requirements related to provider alternative payment reimbursement. The report specifically outlines:
- Which states have capitated, at-risk MCOs
- Whether APMs are included in the MCO’s contract
- Any specific requirements outlined in the MCO contracts
- How each state define APMs
For a detailed summary of the report, check out the article, Medicaid MCO In Your State? There May Be An APM In Your Future, which is available at no cost to the public.
The full report is available free to OPEN MINDS Premium and Elite members in The OPEN MINDS Circle Library: State-By-State Analysis Of Medicaid MCO Requirements For Provider Alternative Payment Reimbursement
The full report can also be purchased in The OPEN MINDS e-store at: https://www.openminds.com/downloads/state-state-analysis-medicaid-mco-requirements-provider-alternative-payment-reimbursement/
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OPEN MINDS is a national strategic advisory firm specializing in the sectors of the health and human service industry serving individuals with complex support needs: mental health; addiction treatment; children & family services; intellectual & developmental disabilities; chronic disease management; long term care; social services; correctional health care, reentry & diversion; and juvenile justice.
Founded in 1987 and based in Gettysburg, Pennsylvania, the 75+ associates believe by providing the latest market intelligence and management best practices to organizations serving the health and social support needs of the most vulnerable consumers, those organizations will be better able to provide efficient and effective services. Learn more at www.openminds.com.
For additional questions and inquiries, please contact Tim Snyder, Executive Vice President, OPEN MINDS at 717-334-1329 or openminds@openminds.com.