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CMMI Prioritizes Multi-Payer Alignment in New Models

NCQA

The Innovation Center also released the Making Care Primary (MCP) model and the GUIDE model this year, innovative solutions to achieve multi-payer alignment and focus on populations that have historically been underfunded in health care.

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Primary Care Case Management in Medicaid: A Strategy for Supporting Primary Care in Rural Areas

NASHP

Primary care case management (PCCM) programs are one of the oldest types of Medicaid managed care, but over time most states have shifted to use managed care organizations (MCOs) to deliver services to Medicaid participants. ii] Rural areas are highly likely to suffer from shortages of primary care and other providers.

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State Community Health Worker Models

NASHP

ACO Accountable Care Organizations. CBCM Community Based Care Management Program. NCQA National Committee for Quality Assurance. PCCM Primary Care Case Management. PH-MCO Physical Health Managed Care Organization. Acronym Guide. APM Alternative Payment Model. CBO Community Based Organization.

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Community Health Worker Models

NASHP

Idaho reimburses for CHW services through its Medicaid managed care (Primary Care Case Management) program. The PCCM program incentivizes primary care providers to incorporate CHWs into their care coordination model by offering a higher per-member per-month (PMPM) case management payment.

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National Care Coordination Standards for Children and Youth with Special Health Care Needs (CYSHCN): Proceedings from the National Forum on Care Coordination for CYSHCN

NASHP

As a result, services were better aligned and the MCOs referred CYSHCN to the Title V CYSHCN program for care coordination given the program staff’s expertise in serving this population. Data are central to both direct care coordination service provision, as well as care coordination system monitoring and quality improvement efforts.