Do Current Medicaid Policies Impact Continued Innovation? An Examination of the Value Based Model Experiment

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Advisor: Sanford Barth, Thomas Jefferson University, Philadelphia, PA.


Medicaid has emerged as a payment reform innovator with Value Based Purchasing (VBP) efforts. This paper examines whether current Medicaid policies help or hinder these efforts and whether these current policies impact cost goals, quality improvement goals and improved access in those states that have expanded Medicaid versus those that have not expanded Medicaid coverage. Cost, quality and access to care challenges are constant in the Medicaid program due to lack of program funding, lack of continuity in programming across states, Medicaid’s revolving enrollee eligibility and the general health of the Medicaid eligible population. To date, thirty one states have begun Medicaid expansion efforts, which allows for full Federal funding for a period of three years, phasing down to 90% funding by 2020. There are additional options for funding through delivery system transformation efforts, and expansion states must use these and other opportunities to control costs, improve quality and allow access to services. Input from many different stakeholders, in conjunction with support from the policy side have given rise to “out of the box” thinking on how to best support delivery system reform and transformation towards a value based system in programming. In Medicaid expansion states, these types of policies and activities advance innovation in cost reduction, quality improvement and access to services. Two examples are the Delivery System Reform Incentive Payment (DSRIP) efforts, and the Medicaid Innovation Accelerator Program (IAP). Through examination of these policies and their achievement, there is room for additional policy enhancement in order to foster the culture of sustainability, collaboration and alignment and to create overall improvements in cost, quality of care rendered and access to services for Medicaid beneficiaries.

Presentation: 23 minutes

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