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  • State Options That Expand Access to Medicaid Home and Community-Based Services

    Report

    This background paper examines various aspects of the Medicaid program that can expand access to home and community-based services (HCBS) and rebalance long-term care spending in favor of HCBS. As a result of the long-standing requirement that states cover facility-based care, the majority of Medicaid long-term care (LTC) expenditures historically have been for institutional, rather than home and community-based, services. Over the past two decades, major efforts have been undertaken by states and the Centers…

  • Innovative Medicaid Initiatives to Improve Service Delivery and Quality of Care: A Look at Five State Initiatives

    Report

    A number of states have used the flexibility of the Medicaid program to develop innovative payment and delivery systems designed to coordinate and improve quality of care. This brief, based on site visits from November 2009 through March 2010, highlights care coordination and related efforts in five states: Alabama, Oklahoma, Oregon, Pennsylvania and Washington state. Such efforts by states to realign the provider payment and delivery systems are key to improving Medicaid and to successfully…

  • Proposed Models to Integrate Medicare and Medicaid Benefits for Dual Eligibles: A Look at the 15 State Design Contracts Funded By CMS

    Issue Brief

    This brief summarizes 15 states' preliminary proposals to better coordinate care for people who are in both the Medicare and Medicaid programs. The design contracts, funded by the federal Center for Medicare and Medicaid Innovation (CMMI), are an outgrowth of new efforts under the health reform law to develop service delivery and payment models that integrate care for the nation’s nearly 9 million "dual eligibles," whose medical needs and health care costs typically exceed those…

  • 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.…

  • Strengthening Medicaid with Health Information Technology: Are Providers & States Up to the Challenge?

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    Health care providers can receive Medicare and Medicaid payment incentives when they adopt electronic health records and demonstrate their "meaningful use." Additionally, states must establish a website by 2014 for Medicaid beneficiaries to electronically enroll and renew coverage. Yet many challenges remain so that health information technology (HIT) can help the Medicaid program operate more effectively. How can Medicaid health plans and providers use HIT to provide better care delivery and improve health outcomes while…

  • A Primer on Dually Eligible Beneficiaries

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    Event

    The nine million dually eligible beneficiaries are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of Medicare and Medicaid spending. Because they often have complex medical and long-term care needs, and must navigate both Medicaid and Medicare benefits and financing, they present a special challenge for those seeking a more efficient and coordinated care delivery system. The panel will address such…

  • Accountable Care Organizations: A New Paradigm for Health Care Delivery?

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    The health reform law of 2010 authorizes Medicare, beginning next year, to contract with accountable care organizations (ACOs) in a Medicare Shared Savings Program. ACOs provide financial incentives to improve the coordination and quality of care for Medicare beneficiaries, while reducing costs. But providers have raised red flags, saying the arrangements are burdensome and too hard to achieve. This briefing addresses questions raised by the law and the subsequent regulation implementing ACOs, including: How will…

  • Innovations in Primary Care: What’s in the ACA?

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    The Patient Protection and Affordable Care Act aims to move the health care system away from an episodic, fee-for-service approach and towards a coordinated, preventive model of care delivery. Exactly how does the law encourage innovations in primary care? What roles will states and purchasers of care play in this transformation? This December 13 briefing, cosponsored the Alliance for Health Reform and The Commonwealth Fund, explored this and related questions. For more information, please visit…

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

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    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…

  • Investing in Health IT: What the U.S. and Other Countries Are Learning

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    Recent legislation, including the stimulus package and the new health reform law, invests substantial funds in health information technology which can help prevent medical errors and improve the quality and value of care. However, questions have been raised about the cost of implementation and personal privacy considerations. This briefing addressed questions such as: What have the U.S. and other countries learned from their experience with health IT? How is the adoption of this technology progressing…