Catalyst for Payment Reform

Finding strengths in differences, the benefits of partnering with state Medicaid agencies!

Finding strengths in differences, the benefits of partnering with state Medicaid agencies!

At CPR, we believe that one purchaser alone cannot move the market, but many purchasers working together toward a common goal and with a common strategy can create real and lasting change. And it’s not just one type of purchaser either. Purchasers of all sizes and types can be catalysts. That’s why CPR’s membership consists of both large private employers and state Medicaid agencies. At first glance, it may seem like an odd pairing, because one entity is a private company with other business and the other is a state-run, government entity that pays providers directly. But consider this:

  • Medicaid programs across the U.S. cover a huge proportion of the U.S. population. In the 51 states reporting September 2017 data, at total of 68,239,620 individuals were enrolled in Medicaid.
  • Many state Medicaid programs are pushing for the same payment reform and benefit design innovations as large employers to achieve higher quality, lower cost care for members.
  • Many state Medicaid agencies are customers of the same major health plans that large employers work with, such as Aetna, UnitedHealthare, Cigna, and the Blues.

Given these important characteristics that Medicaid agencies and private companies share, its only logical that they should band together to have an even greater impact! In fact, creating alignment between public and private purchasers can spark and solidify change in the market and encourage the cross-fertilization of ideas and solutions. Take, for example, Tennessee’s Episodes of Care Initiative that is implementing more than 75 episodes of care for procedures or conditions. Both TennCare, the state’s Medicaid Agency, and the State of Tennessee, Benefits Administration, which provides benefits on behalf of state employees, participate.

But this alignment takes a certain level of coordination and we need more purchasers who are aware of how working in tandem with state Medicaid agencies can lead to significant benefits.

Listen to our December 2017 webinar as two state Medicaid agencies share their insights on the issues these agencies are looking to tackle, the solutions they are implementing, what can employers and purchasers do in conjunction with state Medicaid agencies to help drive forward solutions and collective interests, and the benefits and challenges of partnering with state Medicaid agencies for both the Agency and employers.


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