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Capitalizing on Medicaid APMs

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Deloitte has studied Medicaid alternative-payment models (APMs) to see how payers and others can best capitalize on them. The consulting firm looked at:

  • Patient-centered medical home initiatives.
  • Medicaid Health Homes.
  • Episode of care payments.
  • Accountable Care Organizations.

The firm concluded that:

  • “Many states are taking advantage of Medicaid program flexibility and federal financing to implement APMs in a variety of ways.
  • “Although many state initiatives are underway, relatively few have been evaluated for their impact on total cost of care of health outcomes.
  • “The potential impact of Medicaid alternative payment models on care delivery can depend considerably on how much of a provider’s revenue comes from Medicaid.
  • “Medicaid models may need to evolve to incorporate more financial risk and increase participants’ meaningful use of electronic health records (EHRs) to qualify as advanced APMs under MACRA.’’

“Despite limited evidence, APMs continue to spread, and federal and state policies are increasing pressure on providers and insurers to participate. Aligning Medicaid AMPs’ design, reporting requirements, and financial incentives with other payers could potentially increase their impact and likelihood of success. This could be particularly true for specialists or other providers who treat a low volume of Medicaid patients.’’

To read the report, please hit this link.




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