On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.
Considerations for State Development of Performance Measure Sets
Beth Waldman and Michael Bailit, Bailit Health Purchasing, LLC
As states play a more active role in health care delivery system and payment reform, Medicaid programs have joined other public and private sector purchasers in measuring performance as part of value-based purchasing initiatives. While essential to value-based purchasing, performance measurement can create a significant administrative burden for providers. This burden can grow significantly when individual payers (e.g., insurers, managed care plans, and third-party administrators) utilize different measures. There is a growing interest by Medicaid programs and other payers in developing common measure sets to reduce administrative burden on providers and send a common message to them about performance accountability. This guide provides an overview of the steps states should take in developing a performance measure set—either on their own or in partnership with others—identifies critical considerations, and offers guidance in selecting measures.