- Responsible Medicaid rate-setting processes that take into account different types of Medicaid managed care plans, including industry standards for assessing actuarial soundness;
- Development of comprehensive provider networks that meet the full range of patient needs, including strategies for recruiting and retaining primary and specialty care providers;
- Methods for evaluating quality of care, including clinical measures, or other metrics for evaluation;
- Clinical and other interventions that coordinate care, especially related to the management and treatment of chronic diseases for higher-risk, higher-cost enrollees, and enrollees requiring long-term services and supports;
- Effective policies or programs to communicate with and provide services to vulnerable populations, such as enrollees with disabilities, those who speak English as a second language, those who live in rural or medically underserved areas, etc.
- Collecting, using and reporting complete, accurate and reliable encounter data;
- Effective strategies to enhance program integrity and prevent improper payments, including the use of data and analytics, information security protocols, billing standards, and drug abuse prevention and diversion strategies;
- Accountable management culture and processes, including developing a workforce capable of responding to enrollee needs, implementing effective and responsive grievance procedures, and providing enrollees with access to relevant information about services and programs;
- Constructive means of engaging and collaborating with states or other partners, including communications, legal, organizational or other strategies.
If you like what you see here, get a FREE 30-DAY all-access pass to Healthcare Lighthouse. Lighthouse Beacon will elevate and illuminate your understanding of Federal health policy, at an unbeatable price. TRY IT FREE FOR 30 DAYS.
Not only will you unlock access to all components of our site, including ACA Explained, CRS Vault, LightSearch and the Event Calendar, you’ll get a daily snapshot of the key press clips, regulatory updates and other developments driving your day through LightNews Daily.View More