New York State 1115 Medicaid Waiver Amendment: Social Care Networks
One of the main initiatives in New York’s just under $7.5 billion 1115 Medicaid waiver amendment is the formation of 13 regionally based Social Care Networks (SCN) that will be responsible for building, maintaining and strengthening networks of Community-Based Organizations (CBO) to deliver health-related social needs (HRSN) services. The Request for Application (RFA) window to become an […]
2023 Health Care Forecast, Trends and Key Issues
1. Continued transition to more value-based payment and risk for all lines of business 2. Staffing crisis driving access challenges and financial pressures on hospitals and health systems in particular 3. Population health management/value-based payment EDW for health systems, IPAs, CINs is on the rise 4. Social Determinants of Health (SDoH) and the drive towards […]
California Continues to Shape Payer & Provider Alignment to Address Social Drivers of Health & Health Equity
With the heaviest burdens of the pandemic falling disproportionately on Californians who are low-income Black and Latino and on frontline workers, the need to implement targeted solutions to address long-standing Social Drivers of Health (SDoH) and health equity is at an all-time high. This is reinforced by the principles and goals of California’s newest Medicaid […]
Medi-Cal Equity and Practice Transformation in California
Over the last couple of years, the COVID-19 Public Health Emergency (PHE) laid bare the disparities in health care in disadvantaged communities with preventive and routine care for chronic conditions was delayed in many cases. The California Department of Health Care Services (DHCS) has proposed a one-time investment for Equity and Practice Transformation of $700 […]
Medi-Cal Procurement Requirements Push the Managed Care Envelope: What Health Plans and Providers Need to Know
California is staking out bold new requirements for commercial health plans interested in providing managed care services for Medi-Cal, the state’s Medicaid health insurance program for low-income children, adults and seniors. Up for grabs are contracts to provide Medi-Cal coverage in 33 of 58 California counties and for 38% of the state’s Medicaid population. Roughly […]
Medi-Cal Pharmacy Carve-out: What You Need to Know and Should Do
The State of California is “carving out” the pharmacy benefit for Medi-Cal beneficiaries from managed-care plans and transitioning to a fee-for-service (FFS) program, moving 13 million Medi-Cal beneficiaries to a new pharmacy program by January 2021. Medi-Cal is taking responsibility from the managed care organizations (MCOs) for one of the key elements of care, the […]