Many states separate, or "carve out," Medicaid financing of behavioral health services from that for other types of health care, but there has been a recent trend in some states toward "carve-ins": combining financing for behavioral health services with the larger pool of Medicaid-covered services. What lessons do other states' experiences offer for California?
This study was a cross-sectional mixed-methods analysis of in-depth multimodal data from 31 POs affiliated with 22 purposefully selected health systems in 4 states. Data were analyzed from June 2019 to September 2020.
New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. It may be time to consider limiting audio-only visits in the pursuit of health equity.
Churning—frequent moving in and out of Medicaid due to income fluctuation—increases insurance coverage gaps, disrupts access to health care, increases unnecessary administrative burden, and leads to suboptimal health outcomes. Federal and state policymakers might consider continuous eligibility to help stabilize Medicaid enrollment.
Uncertainty can surround the effectiveness or cost-effectiveness of a new medicine, making it difficult to agree on a medicine's price. One solution to avoid unduly delaying or restricting patients' access is to link the medicine's price to the outcomes it produces in a patient. Despite some barriers, outcome-based payment could offer a “win” for patients, the NHS, and industry.
This report examines whether two components of New York State's Medicaid Section 1115 Waiver—the Managed Long-Term Care (MLTC) program and the 12-month continuous eligibility policy—have achieved their goals.
This study examines implementing an outcome-based payment model in the NHS, the quality and completeness of data on patient outcomes, implications for collecting such data, and establishing steps for the implementation of a pilot OBP scheme.
In this report, the authors address how the Centers for Medicare & Medicaid Services might improve the methodology used in practice expense (PE) rate-setting, update data that inform PE rates, or both.
The typical stakeholders, relationships, and financial incentives involved in prescription drug supply chains vary depending on the characteristics of a drug and how it reaches patients. Differences in business practices complicate a universal description of drug supply chains.
This report explores issues related to VBP and health system preparedness and resiliency to inform discussions about policy options for jointly promoting value, efficiency, and preparedness in the health care system.
This report describes how the Centers for Medicare & Medicaid Services could use claims-based data on post-operative visits to adjust the valuations of surgical procedures with 10- and 90-day global periods.
The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in 2018 and paid for by Medicare. This report follows an earlier report that summarized these patterns from July 1, 2017, through June 30, 2018.
The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in calendar year 2019 and paid for by Medicare. This report follows two earlier reports that summarized these patterns for earlier periods.
Republicans who buy individual health plans may be less likely to shop through marketplaces created under the federal Affordable Care Act, leading them to forgo subsidies provided by the federal government.
The RAND team gathered input from experts about stratified reporting by Part D low-income subsidy (LIS) and dual eligibility (DE), and disability and assessing social risk factors of Medicare Advantage (MA) and Part D contract beneficiaries.
Given the growing pressures on health care systems globally and the need for innovative approaches to financing health care, the time may be ripe to develop a robust evidence base and share learning on fintech-enabled approaches that could support universal health coverage agendas and healthier and more stable societies.
RAND researchers gathered information on how health care prices are set, price variation in health care markets, barriers to price and quality transparency for consumers, and the extent to which price and quality information is used in marketing.