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On Thursday, January 26 State Health and Value Strategies co-hosted a webinar with the Social Interventions Research & Evaluation Network (SIREN) at the University of California San Francisco on the new social care quality measures that will launch from many federal and some state agencies. The measures target a range of payer and delivery system reporting entities. They include requirements around social risk screening and, in some cases, social care interventions. The marked variation across these initiatives highlights a key question: How do we define and measure high quality social care?   

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Date Created: Jan 26, 2023
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States are using a variety of approaches to measure and incentivize Medicaid managed care (MMC) entities to address unmet social needs that can contribute to poor health outcomes, lower quality care, and higher medical expenditures. This toolkit identifies examples of approaches states are taking through their MMC programs to address health-related social needs. States interested in implementing specific strategies related to SDOH can use this toolkit to develop managed care procurements or update and operationalize key contract provisions. This toolkit was co-funded by the Health Foundation of South Florida.

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Date Created: Oct 4, 2022
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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.

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Date Created: Nov 12, 2021
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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.

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Date Created: Nov 4, 2021
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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.

 

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Date Created: Oct 15, 2021
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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.

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Date Created: Sep 9, 2021
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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.

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Date Created: Jun 14, 2021
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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.

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Date Created: Mar 9, 2020
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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.

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Date Created: Jan 23, 2019
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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

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Date Created: Oct 23, 2018