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Issue Briefs , Templates & Toolkits

This suite of issue briefs is geared toward states interesting in value-based purchasing for health care. Part 1 deals with strategic considerations, Part 2 offers an implementation guide, while Part 3 includes a planning template for state purchasers.

Date Created: Jan 22, 2015


Issue Briefs

In this issue brief, The Institute for Patient- and Family-Centered Care (IPFCC) outlines action-oriented recommendations and strategies to support enhanced individual and family engagement efforts in Medicaid. Research shows that engaged individuals and families actively working with their health care teams have better outcomes, often choose less expensive options when participating in shared decision-making, and express greater satisfaction with their health care experiences.

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Date Created: Jan 16, 2015


Issue Briefs

Based on interviews conducted with I/DD staff in six states, this paper highlights approaches to integrating services within the Medicaid program for individuals with I/DD, and lessons learned from states with integration activities underway.

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Date Created: Jan 5, 2015


Issue Briefs , State Materials

Between October 2013 and April 2014 access to health insurance in Oregon expanded in two ways, leading to unprecedented changes in insurance coverage in the state. First, the state extended Medicaid coverage to many previously ineligible low-income adults. Second, the state created a health insurance marketplace that provided a resource where individuals could learn what they are eligible for, explore financial assistance options available to them, and compare commercial plans.

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Date Created: Sep 18, 2014


Issue Briefs

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.

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Date Created: Sep 1, 2014


Issue Briefs , Regulatory Analysis

As health care costs rise, one of the chief determinants of the rate of increase has been the cost of prescription drugs. Over time, additional tiers have been included in pharmacy benefit designs and, as they were added, cost sharing in the new, higher tiers has increased.

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Date Created: Aug 15, 2014


Issue Briefs , State Materials

With the recent conclusion of the initial open enrollment period under the Affordable Care Act, opportunities now exist to examine the experiences and successes of several state-based marketplaces in order to evaluate how they reached consumers and enrolled them in Qualified Health Plans

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Date Created: Aug 15, 2014


Issue Briefs , Regulatory Analysis

As the 2015 open enrollment period approaches, one of the most significant challenges faced by marketplaces stems from the complicated nature of premium subsidy calculations, which may lead to potentially large swings in consumers’ after-subsidy premiums and tax liability implications.

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Date Created: Aug 7, 2014


Issue Briefs

All-payer claims databases (APCDs) collect and compile medical, pharmacy, and sometimes dental claims, eligibility, and provider files from public and private payers. APCDs are currently being used for a variety of functions, including population health analysis, comparative analysis of provider and facility quality, cost management for Medicaid and other public programs, support for provider payment reform initiatives, and consumer transparency tools.

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Date Created: Jun 27, 2014


Issue Briefs

Under the Affordable Care Act (ACA), individuals seeking health insurance coverage through a Marketplace are assessed for eligibility for an advance payment of the premium tax credit (APTC) based on projected annual income. When eligible individuals file federal income taxes at the end of the year, the Internal Revenue Service (IRS) will reconcile the premium tax credit received based on estimated annual income with what should have been received based on actual income.

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Date Created: Jun 23, 2014