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CST: 16/10/2019 20:18:50   

28 State Medicaid Plans Require VBR Contracting Between Provider Organizations & Health Plans: New OPEN MINDS Analysis

40 Days ago

Gettysburg, Pa, Sept. 06, 2019 (GLOBE NEWSWIRE) -- A new report from OPEN MINDS, Medicaid Health Plan Requirements For Provider Alternative Payment Models: The 2019 State-By-State Update found that 28 of the 40 states with Medicaid managed care require health plans to implement alternative payment arrangements (APMs) with provider organizations. APM is an umbrella term for pay-for-performance fee-for-service (FFS) and valued-based reimbursement arrangements. This is up from 22 states out of 39 states in 2017

These are the findings of a new analysis by the OPEN MINDS market intelligence team. The analysis identifies the states with managed care contract requirements for APMs and the details of those requirements. States with especially notable APM requirements include Washington and New York both of which have value-based roadmaps intended to drive changes in financing in delivery. New York plans to have 80 to 90% of payments in value-based reimbursement (VBR) arrangements by the end of 2020 and Washington plans to have 75% of payment in VBR by the end of 2019 and 90% in 2021. While Arizona, Pennsylvania, and New Mexico do not have requirements to move such a high percentage of payments to APMs in the near term, these states have specific requirements around the inclusion of behavioral health provider organizations in APMs.

“The increase in the number of states requiring APMs as well as  the increasing percentage of payments in APMs is indicative of the trend that VBR is reshaping the health and human services landscape. The pressure for VBR is not only coming from the state and government, but also from private sector as health plans work to implement these initiatives with or without a mandate” said OPEN MINDS Market Intelligence Director Athena Mandros.” Provider organizations regardless of the state they operate in need to at a minimum begin readying their organization for VBR.”

The new market intelligence report addresses a number of topics related to understanding the Medicaid market including:

  • The six states that added APMs in the past year and a half include: California, Colorado, District of Columbia, Kansas, Louisiana, and Wisconsin
  • States that require health plans to implement APMs
  • How the move to APMs is being measured
  • The state’s definition of APMs

A free summary analysis of the report can be found at: The VBR Mandate – Medicaid Requirements On The Increase. The report, Medicaid Health Plan Requirements For Provider Alternative Payment Models: The 2019 State-By-State Update, is available at no charge to Premium and Elite members of The OPEN MINDS Circle and can be purchased in the OPEN MINDS shop for $495.

About OPEN MINDS

OPEN MINDS is an award-winning information source, executive education provider, and business solutions firm specializing in the domains of health and human services serving consumers with chronic conditions and complex support needs. For thirty years, we’ve been pioneers for change—helping organizations implement the transformational business practices they need to succeed in an evolving market with new reimbursement, competition, policies and regulations.

OPEN MINDS is powered by a national team of experienced executives and subject matter experts with specific expertise and experience in nine key market areas—mental health, addictions, chronic conditions, autism and intellectual/developmental disabilities, long-term care, children’s services, social services, juvenile justice, and corrections health care. Our mission is to improve the quality of care for consumers with complex support needs by improving the effectiveness of those serving them—provider organizations, payer and insurance organizations, government agencies, pharmaceutical organizations, and technology firms. Learn more at www.openminds.com

Athena Mandros
OPEN MINDS
717-334-1329
amandros@openminds.com

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