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.
Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care
Bailit Health Purchasing—Megan Burns, Mary Beth Dyer, and Michael Bailit
Overuse and misuse of health care services are problems that affect both quality and cost of care. Experts estimate that perhaps one-third of all U.S. health care spending produces no benefit to the patient–and some of it actually results in harm. This issue brief focuses specifically on the key purchasing strategies that state Medicaid agencies and state employee health benefit purchasers can implement in order to reduce the overuse and misuse of health care services, and improve the quality and reduce the cost of care. This brief primarily focuses on actions state purchasers can take with contracted plans, providers, and other engaged purchasers to reduce overused and misused services.
Based on the issue brief, the webinar presentation focuses on actions state purchasers can take with contracted plans, providers, and other engaged purchasers to reduce misuse and overuse of health care services. Neal Kohatsu MD, MPH offers insight on overuse and misuse from his perspective as Medical Director for the California Department of Health Care Services.