An extensive body of research reports on poor birth-related outcomes and disparities in maternal mortality and morbidity in the United States, particularly for individuals enrolled in Medicaid. Importantly, Medicaid provides healthcare coverage to individuals who may otherwise not be eligible for coverage until pregnancy, until which time they may have been uninsured or under-insured and have untreated health conditions or lack access to routine care. As states start to tackle institutionalized racism in the healthcare system, they are considering approaches to center health equity by addressing disparities in birth outcomes. This issue brief describes the drivers of birth-related health disparities and identifies purchasing and payment strategies to support state efforts to reduce disparities in birth outcomes. The brief focuses specifically on actions Medicaid agencies can pursue through their managed care programs or directly with provider organizations to promote health equity and improve birth outcomes.
To explore enforcement considerations across potentially multiple state agencies, State Health and Value Strategies hosted a webinar on Thursday, November 4 at 1:00pm ET, during which experts from the Georgetown University Center on Health Insurance Reforms and GMMB provided an overview of federal regulators’ proposed approach to enforcement of the NSA as well as shared strategies to consider in planning provider and consumer education efforts. The webinar also included presentations from three states on their enforcement approaches to the NSA: Maryland, Pennsylvania and Texas, followed by a question and answer session.
COVID-19, the resulting behavioral health crisis (including those related to mental health and substance use disorders), and calls for law enforcement reform related to behavioral health crisis response have heightened the urgency among federal, state, and local policymakers to expand access to behavioral health crisis services. Recently, the federal government has provided new funding opportunities to states to improve access to behavioral health crisis services, including mobile crisis services. As states review the opportunities available to begin, enhance, or expand mobile crisis intervention services under the American Rescue Plan Act of 2021, policymakers may further consider a hybrid funding model that provides mobile crisis providers with a consistent and steady stream of funding to ensure they are able to maintain 24/7 availability and respond in a timely manner to all individuals in crisis, regardless of insurance status. Such a new model for funding mobile crisis services could also be designed to hold payers accountable for covering mobile crisis services when their enrolled members use this essential resource. This issue brief presents a sustainable, hybrid coverage and funding approach for mobile crisis services.
Promoting Health Equity in Medicaid Managed Care: A Guide for States describes recommended process steps for states to integrate a focus on health equity in their Medicaid managed care programs. It offers a series of concrete steps to be more intentional about advancing health equity in Medicaid, and specifically through Medicaid managed care programs. The guide focuses on the internal agency commitments and changes that are necessary to address systemic barriers to accessing high quality health care and improving health outcomes, particularly among populations that experience persistent health inequities. It is organized into three primary sections, each containing specific actions for Medicaid agencies.
On Monday, June 14, State Health and Value Strategies hosted a webinar during which experts from Manatt Health provided an overview and considerations on the state option to provide community mobile crisis interventions services included in American Rescue Plan. Presenters walked through key questions on the new option, reviewed promising models for crisis mobile intervention services, and shared strategies for equitable design and implementation. The webinar also included a question and answer session during which webinar participants posed their questions to the experts on the line.
This issue brief describes select policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement. In some cases, the Medicaid agency will be responsible for implementing these policies; in other cases, the Medicaid agency can lead collaboration with other state agencies such as the public health department or the state marketplace.
On January 23, State Health and Value Strategies hosted a webinar examining the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment. State Medicaid programs commonly rely on contracted Managed Care Organizations (MCOs) and their subcontracted Pharmacy Benefit Managers (PBMs) to manage the prescription drug benefit offered to Medicaid enrollees. The webinar offered states real world tips on how to best monitor and evaluate operational and financial performance of their MCOs and their subcontracted PBMs.
On October 23, State Health and Value Strategies hosted a webinar that explored state options for regulating provider risk-bearing organizations. The push to better manage costs and improve quality is resulting in payment models that transfer financial risk and accountability from payers to providers. An increasing number of provider organizations are entering into risk-based contracts with payers where they are accepting the financial risk of care. This financial liability is often shared with payers, and maximum risk exposure is typically capped. During the webinar, technical experts from Bailit Health reviewed approaches states could take to overseeing their risk-bearing organizations and highlighted examples from states that have elected to regulate to protect against provider insolvency. Click here to access webinar slides
There is an extensive body of evidence that shows social determinants of health (SDOH) play a powerful role in shaping health and health outcomes. State policymakers are increasingly focused on SDOH because of the influence they have on health, health care outcomes and Medicaid spending. As state Medicaid agencies consider addressing SDOH, there are a range of models they can employ. State Health and Value Strategies (SHVS) has published resources and hosted webinars with information for state health officials on approaches to addressing SDOH. This State Health Policy Highlight profiles two issue briefs and a webinar produced by SHVS on the topic of how state Medicaid programs can address SDOH.
An increasingly common feature of health care payment models is the transfer of financial risk from payers to providers for health care services delivered to a defined population of patients. In these “value-based payment” models, providers accept financial responsibility should spending for most, or all, services for an attributed patient population exceed targeted levels. This financial liability is often shared with payers, and maximum risk exposure is typically capped. This issue brief explores options for states as they consider oversight of risk-bearing organizations, with a focus on states that have elected to act to protect against provider insolvency.
State Health and Value Strategies hosted a companion webinar, Safeguarding Financial Stability of Provider Risk-Bearing Organizations, based on the issue brief that provided an overview of options for states as they consider oversight of risk-bearing organizations (RBOs) as well as a deeper dive on the Massachusetts approach.