Adults with chronic conditions make up approximately 40 percent of the Medicaid population. Yet costs for their care account for more than 80 percent of Medicaid's expenditures. While a limited number of innovative approaches for caring for this population are being pil... more
Coordinated care organizations (CCOs) are an emerging type of comprehensive managed care program within Medicaid for adults with disabilities and complex chronic illnesses. Yet definitive outcome measures are mostly absent for these complex needs populations. Based on t... more
Population-based payment (PBP) models — an advanced value-based payment approach — are gaining increased interest in health care as a way to achieve often hard-to-reach goals, such as controlling health care costs, improving care quality, enhancing patient and prov... more
Medicaid currently covers more than 40 percent of the nation's long-term care needs. Yet close to 95 percent of beneficiaries needing long-term care are in fragmented fee-for-service programs. Overhauling the delivery of Medicaid long-term supports and services (LTSS) o... more
Family run organizations across the country are lead providers of peer support services for children, youth, and young adults affected by serious emotional, behavioral, and mental health challenges and their families. The mission of most family run organizations include... more
The health care needs of children in foster care are vast and compounded by their circumstances. Because they are often at the intersection of multiple public systems including behavioral health, child welfare, education, juvenile justice, and primary care, it is critic... more
This toolkit offers a structured approach for addressing quality improvement and a collection of "lessons learned" by a diverse group of health plans serving Medicaid members. Whether your health plan intends to develop a new asthma management program or is seeking to i... more
Sharing data across state agencies and community-based organizations is critical for advancing health equity and addressing complex health challenges that involve multiple sectors. Insights from individuals with lived expertise provide valuable context to inform data-s... more
This Best Clinical and Administrative Practices (BCAP) toolkit reflects the experiences of the Improving Managed Care for Children with Special Needs workgroup -- 11 health plans and a primary care case management (PCCM) program that collaborated over 24 months to devel... more
The Affordable Care Act presents Medicaid with significant opportunities to redesign the primary care delivery system to achieve better outcomes and more cost-effective care. In particular, small practices that serve large numbers of Medicaid beneficiaries can benefit f... more
Provider practices juggling diverse patient needs and overbooked appointment rosters often lack time to address the significant social, economic, and environmental barriers standing in the way of their patients' health. Given the day-to-day hurdles many patients face, i... more
Nursing homes are largely funded through taxpayer dollars, including through the federal Medicare and state Medicaid programs. States, however, have the primary responsibility for oversight of nursing homes to ensure that these facilities are meeting state and federal r... more
