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Tag: Medicaid

Assessment of Washington State’s Medicaid Prescription Drug Management Performance and Policy Options

This report explores which prescription drug model is best suited for Washington’s Apple Health (Medicaid) program: the current carve-in prescription drug model, under which managed care organizations (MCOs) pay for members’ prescriptions, or a carve out model, where prescriptions are…

Oct. 21, 2024 Download Full Report

KEYWORDS:Expenditures, Medicaid, Pharmacy Carve Out, Prescription Drugs

Optimizing Medicaid MCO Procurements

This edition focuses on Medicaid MCO procurements, an area where our company conducts vast project work. We describe a few actions states can take to get the most value out of their procurements. We also offer some thoughts regarding how…

Sep. 12, 2024 Download 5 slide

KEYWORDS:Medicaid, Procurement

Medicaid MCO NCQA Accreditation Tabulations: Rating Year 2022-2023

This 5 Slide Series edition provides our tabulations and analysis of NCQA’s Quality Ratings for Medicaid MCOs juxtaposed with the specialized accreditations NCQA has awarded to these health plans.

May. 9, 2024 Download 5 slide

KEYWORDS:Medicaid, Quality

Medicaid MCO Quality Tabulations: NCQA Rating Year 2022-2023

This 5 Slide Series edition provides our tabulations and analysis of the NCQA Quality Ratings for Medicaid MCOs (Rating Year 2022-2023).

May. 9, 2024 Download 5 slide

KEYWORDS:Medicaid, Quality

Medicaid MCO Innovations to Address the Opioid Epidemic

This edition provides excerpts of opioid-related questions that have appeared in Medicaid MCO procurements. These slides demonstrate some of the ways in which states are using their request for proposal (RFP) process to promote innovation and elevate the MCOs’ mechanisms…

Apr. 25, 2024 Download 5 slide

KEYWORDS:Medicaid, Policy, Prescription Drugs

Costs and Benefits of Enhancing Private Duty/Shift Nursing Payment Rates in Pennsylvania’s Medicaid Program

This report was enlisted by the Pennsylvania Homecare Association to evaluate the need for enhancing Pennsylvania’s Medicaid Private Duty Nursing (PDN) payment rates. Through a mixture of quantitative analyses and real-life patient examples, this report highlights the anticipated benefits this…

Apr. 25, 2024 Download Full Report

KEYWORDS:Expenditures, Medicaid, Policy

Quantifying the Impact of State-Level Policy Changes on Opioid Prescription (and Unit) Volume

This edition looks at various state-level policy changes seeking to restrict inappropriate use of opioids, conducting a pre-versus-post comparison of prescription opioid usage related to the dates of these policy changes.

Mar. 30, 2024 Download 5 slide

KEYWORDS:Medicaid, Policy, Prescription Drugs

Costs and Benefits of Enhancing Private Duty Nursing Payment Rates in Colorado’s Medicaid Program

This report was commissioned by the Home Care and Hospice Association of Colorado. The report derives the Medicaid payment rate increase needed to attract adequate private duty nursing (PDN) service capacity in Colorado. We’ve estimated the cost to the Medicaid…

Mar. 12, 2024 Download Full Report

KEYWORDS:Expenditures, Medicaid, Policy

Trends in the Use of Prescription Opioids and MAT in the Medicaid Program

This edition focuses on the trends in Medicaid prescription opioid and MAT use. An example of our findings is that opioid prescriptions per Medicaid enrollee decreased 54% from 2013-2022.

Feb. 26, 2024 Download 5 slide

KEYWORDS:Medicaid, Prescription Drugs

Trends in Opioid and Medication-Assisted Treatment Prescription Drug Usage in Medicaid

This report describes trends in opioid and medication-assisted treatment (MAT) prescription drug usage in Medicaid, put together for a presentation at a recent opioid conference.

Feb. 16, 2024 Download Full Report

KEYWORDS:Medicaid, Prescription Drugs