Catalyst for Payment Reform

Medicaid MCOs as Agents of Change in Payment Reform

Medicaid MCOs as Agents of Change in Payment Reform

Medicaid agencies have been among the pioneers in the implementation of payment reform.  There is much to learn from their efforts, the considerations and trade-offs they face, and how they use their managed care contracts to help realize their goals.

CPR is pleased to offer a resource for employers and other health care purchasers, including Medicaid agencies, that assembles key contract provisions from across the 39 states with Medicaid Managed Care and the District of Columbia.

The resulting compendium document catalogues the strategies Medicaid agencies are pursuing to accelerate growth and innovation in payment reform through mandates to their MCO contractors.  This resource is designed to help Medicaid agencies, employers and other health care purchasers learn from each other, and to spur continued innovation and accelerate effective payment reform.

The compendium includes:

  • An overview of the landscape and prevalence of payment reform strategies in Medicaid Managed Care states
  • Profiles of pioneering states and programs that leverage MCOs as instruments of payment reform and care delivery transformation
  • Language directly excerpted from MCO model contracts instructing MCOs on the goals, targets and mechanisms for executing payment reform.  The excerpts include general provisions for payment models, and programs specifically aimed at maternity care, behavioral health, pharmacy, provider enablement and social determinants of health.

Alongside the compendium release, CPR held a virtual summit with medicaid leaders and Beth Waldman of Bailit Health, a Medicaid contract expert. Watch the recording below, or scroll down past the video to download the compendium.

Watch the Virtual Summit, and Download the Tool Below!

Type: Sourcing & Contracting Tool