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As health insurance marketplaces continue to approach the fourth open enrollment period, the development of innovative models and partnerships for reaching consumers becomes increasingly important. During the third open enrollment period, MNsure, Minnesota’s state-based marketplace, designated and supported twenty broker-operated enrollment centers around the state, which made a series of special commitments to promote enrollment through the marketplace. Determining the efficiency and effectiveness of such efforts is critical for the planning and development of future efforts undertaken by marketplaces.

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Date Created: May 31, 2016
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With health care providers increasingly being rewarded based on changes in cost of care, it is critical that sufficient statistical safeguards are in place to ensure that payment arrangements fairly reflect provider performance rather than random variation in medical utilization. The underlying changes in cost of care for populations served by patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) are difficult to accurately assess when there are a small number of attributed patients.

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Date Created: Apr 26, 2016
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Changes in population-based payment models in health care delivery have spurred enhanced efforts toward closer integration between state purchasers of health care and state, county, and local public health officials. This issue brief, developed by Bailit Health Purchasing LLC and Dr. Karen Hacker, investigates approaches that state agencies might employ in order to better integrate public health and health care delivery as a means of improving health and the value of health care, and it is organized according to seven features of integration. The issue brief is accompanied by three case studies providing additional detail to some of the examples cited in the brief.

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Date Created: Mar 30, 2016
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Recent guidance released by the Centers for Medicare and Medicaid Services (CMS) in February 2016 increases the range of Medicaid services and providers for which states may claim full federal funding. States with significant American Indian and/or Alaska Native (AI/AN) populations stand to benefit from this increased federal Medicaid funding. This issue brief, developed by Manatt Health, summarizes the new policy expanding federal funding for state Medicaid services provided to AI/AN populations, and explains the ways in which these additional funds reduce the cost of Medicaid expansion for states.

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Date Created: Mar 29, 2016
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Provider assessments, fees, and taxes are tools available to states to generate funds to cover the non-federal share of Medicaid payments. This issue brief, developed by the State Network team at Manatt Health, examines two revenue sources that states may utilize to fund the non-federal share of Medicaid expansion: provider assessments and provider donations. Both of these are authorized by federal law and have been used by states in connection with Medicaid expansion. The issue brief summarizes the rules regarding their use and describes the ways in which they have been utilized in several states.

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Date Created: Mar 22, 2016
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In addition to the impact that state decisions to expand Medicaid have had on coverage rates across the country, there is an increasing body of evidence showing consistent economic benefits among these states. This report, prepared by Manatt Health, is an update to an April 2015 State Network report, and examines data regarding Medicaid expansion in eleven states, demonstrating that states continue to realize budget savings and revenue gains as a result of expanding Medicaid.

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Date Created: Mar 22, 2016
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With states increasingly moving to develop population-based payment arrangements with provider organizations, the critical role of safety-net providers has become a challenging consideration for states. While safety-net providers typically lack the capital, experience, and/or scale to operate as an Accountable Care Organization (ACO), their role in state Medicaid programs underscores their integral role in the implementation of a population-based payment strategy with ACOs.

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Date Created: Jan 26, 2016
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The recently released Proposed Payment Notice for 2017 formalizes a fourth model of marketplace – State-Based Marketplace/Federal Platform. Along with State Based Marketplaces, State Partnership Marketplaces and the Federally Facilitated Marketplace, states have a range of choices for what their Marketplace looks like. A key question for states will be how these different models help to achieve coverage goals.

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Date Created: Jan 8, 2016
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In attempting to move toward value-based payments, there exist the inherent challenges posed by the availability of data. States wishing to accelerate the transformation of the existing delivery system into one that delivers high quality and affordable health care have to take action to develop a comprehensive data collection and reporting mechanism. Such an approach can be taken using episodes of medical care as the central unit of measure.

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Date Created: Dec 22, 2015
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Federally Qualified Health Centers (FQHCs) traditionally provide health care services primarily to low-income individuals who are covered by Medicaid or who are uninsured. As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. This brief provides an overview of FQHC cost reporting, delves into state payment reform strategies that Include FQHCs, and offers considerations for states and FQHCs alike.

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Date Created: Dec 14, 2015