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CMMI Prioritizes Multi-Payer Alignment in New Models

NCQA

The GUIDE model is the first of its kind to address health care costs and target reductions in federal spending on long-term nursing home placement. And then we’re also developing an approach for certification based on quality improvement and patient experience.”

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Managing Managed Care: Closing Gaps in Care for Payers, Providers and Members

GoMoHealth

Partnering with Managed Care Organizations and Provider Networks to reduce costs and better manage utilization of health services. By Nakecia Taffa, Quality Improvement and Health Equity Director for GoMo Health. Decreased gaps in care and population disparities : closed gaps in care for engaged members of a U.S.

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States Build Capacity to Address Maternal Mortality through Policy Innovations

NASHP

Iowa’s Medicaid agency and Bureau of Family Health synthesized their strategic planning goals for improving maternal health outcomes and proposed policies to leadership and partners. This will enable the state to increase breastfeeding rates and improve the quality of maternity services delivered in these birthing facilities.

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State Community Health Worker Models

NASHP

ACO Accountable Care Organizations. CBCM Community Based Care Management Program. CHW services could be used for many health conditions as long as there is a care plan in place written by a physician, physician assistant, nurse practitioner, or a certified nurse midwife. Acronym Guide.

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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.

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Community Health Worker Models

NASHP

CHW services could be used for many health conditions as long as there is a care plan in place written by a physician, physician assistant, nurse practitioner, or a certified nurse midwife. There are currently some Accountable Care Organizations (ACOs) that cover the cost of CHW services through Medicaid administrative payments.

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

NASHP

For example, to move from tier 3 to tier 4, the provider must meet all the requirements of tier 3 and several new requirements, such as having a well-established quality improvement process. Using payment to create incentives to improve performance. Oklahoma’s care management and quality departments support the PCCM providers.