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  • CMS’s Final Rule on Medicaid Managed Care: A Summary of Major Provisions

    Issue Brief

    On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued final regulations that revise and significantly strengthen existing Medicaid managed care rules. In keeping with states’ increasingly heavy reliance on managed care programs to deliver services to Medicaid beneficiaries, including many with complex care needs, the regulatory framework and new requirements established by the final rule reflect increased federal expectations regarding fundamental aspects of states’ Medicaid managed care programs.

  • Is AI Better for Patients?

    Podcast

    Is AI Better for patients? What is changing on the ground? Chip talks with Dr. Patrick Conway, Chief Executive Officer of Optum, a health services and technology business under parent company, UnitedHealth Group. They discuss how to ensure the health care industry’s use of AI serves patients first, particularly when the same company bears financial risk and builds the AI that decides who gets care. They also discuss whether use of AI can make value-based…

  • State Delivery System and Payment Strategies Aimed at Improving Outcomes and Lowering Costs in Medicaid

    Issue Brief

    State Medicaid programs are using managed care and an array of other service delivery and payment system reforms, financial incentives, and managed care contracting requirements to help achieve better outcomes and lower costs. This brief examines what delivery system and payment reform initiatives are in place across states; how are states linking financial incentives and using transparency to improve quality and outcomes; and how are states leveraging managed care plan contracts to advance delivery system…

  • Can AI Break the “Measurement Paradigm?”

    Podcast

    How do we know if AI use in health care actually makes patients better? Chip talks with Dr. David Bates — a veteran physician leader at Mass General Brigham and the Brigham and Women's Hospital and Co-director of the Center for Artificial Intelligence and Bioinformatics Learning Systems — about measuring patient outcomes reliably and in real time to create a strong foundation for everything else in health care administration — clinical deployment, payment reform, consumer…

  • The Health Workforce Dream Team: Who Will Provide the Care?

    Event Date:
    Event

    Many providers and policymakers envision team-based care as an important way to improve quality and maximize resources. The “dream team” includes nurses and many other non-physician providers. But how will we ensure enough health care workers for a growing, aging population with ever-increasing chronic care needs? This December 2 briefing, sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation, explored the question, focusing on a new report from the Institute of…

  • Managing Costs and Improving Care: Team-based Care of the Chronically Ill

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    Event

    Treating those with multiple chronic conditions, including the elderly and disabled populations, accounts for 30 percent of total U.S. health care spending. Half of this amount is spent by Medicare and Medicaid on behalf of beneficiaries eligible for both programs. This briefing, cosponsored by the Alliance for Health Reform and The Commonwealth Fund, looked at ways to improve the quality of care for the chronically ill while reducing the growth in spending for their care.…

  • Quality Care for Less Money: Can Regional Successes Go National?

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    Event

    On February 15, the Kaiser Family Foundation hosted an event featuring a PBS documentary with former Washington Post correspondent T.R. Reid – U.S. Health Care: The Good News – which explores efforts to provide low-cost, quality health care in the U.S. The film looks at variations in health spending across the country and showcases efficient health care delivery systems, like Grand Junction in Colorado and Group Health in Seattle, suggesting that these communities demonstrate that…

  • Is AI (Still) Biased? 

    Podcast

    In this episode, Dr. Ziad Obermeyer joins Chip to talk about AI bias in patient management, including how far the health care industry has come since his groundbreaking research that revealed alarming biases in a widely used algorithm that underestimated the health needs of Black patients.

  • Medicaid at 50: A Look Back – And Ahead

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    Event

    Medicaid, the main health insurance program for low-income people and the single largest source of public coverage in the U.S., turns 50 this year. In that time, it has grown to cover nearly 70 million Americans and become a key source of financing for safety net hospitals and health centers, as well as the main source of coverage and financing of long-term care. The program continues to be a focus of policy debate and partisan…

  • Medicaid: What to Watch in 2019 from the Administration, Congress, and the States

    Issue Brief

    Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Important Medicaid issues to watch in 2019 include Medicaid expansion developments amid ongoing litigation about the ACA’s constitutionality as well as Medicaid demonstration waiver activities, including those focused on work requirements and…