The National Association of Medicaid Directors (NAMD) is encouraging state Medicaid directors to share their experiences and challenges regarding current delivery and payment reforms in order to arrive at “high-quality services while reducing the share of healthcare programs consumed in state budgets.”  

In a preamble to a policy brief posted to its website, NAMD recognized that some states, in addressing budget deficits, have turned to what the agency called “blunt instruments,” including cuts to benefits, eligibility and provider rates. NAMD officials said that states are looking for more sustainable reforms.

“Medicaid directors are poised to leverage their influence as state leaders to dramatically reform the provision of health care to millions of beneficiaries of public programs, but often lack the resources to effectuate these improvements,” the association’s statement read.

In its policy brief, NAMD identifies five general categories of payment reforms states currently are considering or pursuing. These include the following:

  1. Targeted payment adjustment policies
  2. Managed fee-for-service
  3. Bundled payments
  4. Managed care initiatives
  5. Health homes

The brief also outlines how, in choosing a policy to implement, states must weigh the different reform models against the readiness of their Medicaid programs, their states’ unique political environments, and their policy goals.

Other remaining considerations include which federal entities to work with, plus how to measure value in terms of the quality of healthcare services and outcomes beneficiaries see compared to the costs invested and savings accrued to the state.

In recognizing that implementing payment reforms remains a “difficult challenge facing state Medicaid directors,” NAMD leaders said such considerations also are imperatives for the sustainability of the program.

“NAMD remains committed to furthering this conversation and to helping state Medicaid directors leverage their purchasing power to improve quality and efficiency in health care for millions of Americans,” the statement concluded.

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