Mathematica Policy Research has released a brief examining managed long-term care.  Focusing on options for New York State, the brief also offers general options available to all states.  The authors also offer options for improving dual eligibles' care.

From the report:

The Federal Coordinated Health Care Office (renamed the Medicare-Medicaid Coordination Office) and the Center for Medicare and Medicaid Innovation are partnering to help states develop integrated care programs for dual eligibles.  CMS selected 15 states on April 14, 2011 to receive contracts of up to $1 million each to help them plan dual eligible demonstration projects.  States selected were CA, CO, CT, MA, MI, MN, NY, NC, OK, OR, SC, TN, VT, WA, and WI.  Planning contracts will be for 18 months, and demonstrations will start in 2012.

Full report: Managed Long Term Care: Options for New York and Examples From Other States (PDF | 197.47 KB)

Mathematica Policy Research.  (2011).  Managed long term care: options for New York and examples from other states.  Verdier, J.

Mathematica Policy Research has released a brief examing managed care opportunities for childless adults under the national health care reform law's Medicaid expansion.  The law explains how the Medicaid expansion will work and who it will make eligible for Medicaid coverage.  The authors also examine opportunities and challenges for managed care under the expansion.

From the report:

Health care reform Medicaid expansion will result in many potential new enrollees for Medicaid MCOs.  High health care needs and costs for low-income childless adults will present significant challenges in terms of outreach, network development, care management, capitated rate setting, and quality monitoring.

Full report: Extending Medicaid Coverage to Low-Income Childless Adults: Opportunities and Cautions for Managed Care Plans (PDF | 149.96 KB)

Mathematica Policy Research.  (2011).  Extending Medicaid coverage to low-income childless adults: opportunities and cautions for managed care plans.  Verdier, J.

Health Affairs has published a study examining 17 states' patient-centered medical home initiatives.  The authors suggest that early findings indicate that the programs have been generally successful, resulting in improve care quality and cost trends.  The report also asserts that the initiatives have improved access to health services. 

Takach, M.  (2011).  Reinventing Medicaid: state innovations to qualify and pay for patient-centered medical homes show promising results.  Health Affairs, 30 (7): 1325-1334.  doi: 10.1377/hlthaff.2011.0170.  http://content.healthaffairs.org/content/30/7/1325.abstract

Author: Mary Takach

The Commonwealth Fund has released a brief examining private sector accountable care organizations’ (ACO) experiences implementing shared payer-provider risk payment models.  Noting that the national health care reform law implements such a model under the Medicare Shared Savings Program, the brief posits that providers currently lack the necessary infrastructure to successfully assume and manage risk.  The authors conclude that providers need improved data and analytic capabilities to negotiate appropriate risk-sharing arrangements with payers and adequately manage risk for affected patient population.

From the report: 

The Medicare Shared Savings Program, a component of the Patient Protection and Affordable Care Act, has accelerated the creation of accountable care organizations (ACOs), payer–provider alliances meant to deliver lower-cost but still high-quality health care via new payment models, particularly ones that reward efficiency. This paper describes and reports on the implementation of eight private ACOs that use, or are planning to deploy, a shared payer–provider risk payment model. Still in an early developmental phase, these payment models vary not only in their design and in how they define shared risk. The authors note that providers currently lack the infrastructure required to take on and manage risk successfully, though some payers are providing such support. Providers will need more data and analytic capabilities to manage the patient populations for which they take on financial risk and to negotiate appropriate risk-sharing arrangements with payers.

Full report: Promising Payment Reform: Risk-Sharing with Accountable Care Organizations (PDF | 568.48 KB)

Commonwealth Fund.  (2011).  Promising payment reform: risk-sharing with accountable care organizations.  Delbanco, S.

The Center for Health Care Strategies, Inc. has released a brief examining the establishment of physician-supported entities (PSEs) in Medicaid.  The authors note that PSEs can help providers improve service delivery through improved quality and efficiency.  The brief offers strategies for Medicaid agencies to facilitate the development of PSEs.

From the report:

Physician-support entities (PSEs) offer an emerging opportunity to enhance the capabilities of evolving physician networks. PSEs can be based on physician, health plan or community organizations that form to provide quality improvement, performance measurement, health information technology, care management, and leadership support to practices. PSEs can also be building blocks to help establish more organized Accountable Care Organizations.

Full report: Creating Physician-Support Entities in Medicaid (PDF | 84 KB)

Center for Health Care Strategies, Inc.  (2011).  Creating physician-supported entities in Medicaid.  Highsmith, N.

The Center for Health Care Strategies, Inc. has published a brief on implementing health homes in risk-based Medicaid managed care systems.  The authors examine how states can advance health home programming within existing risk-based Medicaid managed care systems.

From the report:

Health homes present a significant opportunity for Medicaid programs to change the way care is delivered to some of the
most vulnerable Americans and to curb growing health care costs. Likewise, they also present a transition for MCOs − specifically, an opportunity for them to redefine their role and confirm their value. Innovative and forward-thinking MCOs will recognize and seize the opportunity to position themselves for the future, differentiate themselves from their peers and change care management as we know it.

Full report: Implementing Health Homes in a Risk-Based Medicaid Managed Care Delivery System (PDF | 275.39 KB)

Center for Health Care Strategies, Inc.  (2011).  Implementing health homes in a risk-based Medicaid managed care delivery system.  Hasselman, D. and Bachrach, D.