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Health policy and research


3M clinical researchers and policy experts stay current with hundreds of regulatory and health care market-based initiatives, so you don’t have to. Here you can find resources, education and guidance on many Medicaid and other state initiatives that impact risk adjustment, payment redesign, outcomes-based incentives, health equity and more.

Policy in action

  • Outline of Texas
    Texas hospital averages $30M in gains per year through state incentive program

    Oscar A. Perez Jr., program manager at University Medical Center of El Paso (UMC) discusses strategies employed by UMC to reduce potentially preventable readmissions, successfully meet quality-outcomes benchmarks and attain financial incentives under DSRIP.

    Read the article.

  • Outline of Hawaii
    Hawaii: 3M APR DRG implementation announced

    Beginning with admission dates on January 1, 2022, inpatient acute services for the Hawaii Medicaid program shall be paid using 3M All Patient Refined Diagnosis Related Groups (APR DRGs). Due to APR DRGs’ enhanced granularity (particularly for key Medicaid service lines) and widespread adoption of across states, Med-QUEST (MQD) will use the APR DRG grouper as the patient classification system for its new Medicaid inpatient prospective payment methodology.

    View the posted fee schedules and click on the APR DRG Payment Methodology tab to learn more: Fee Schedules (

    Publication Date: July 2021

    Download the memorandum (PDF, 440 KB).

  • Outline of Idaho
    Idaho: Moving to 3M APR DRGs for inpatient reimbursement

    The Idaho Department of Health and Welfare (DHW) intends to implement 3M™ All Patient Refined DRG (APR DRG) as the payment method for inpatient hospitals stays for the Medicaid program on July 1, 2021. The 3M APR DRG methodology classifies hospital inpatient stays according to the reason for admission, severity of illness and risk of mortality. By using 3M APR DRG Idaho DHW will have a better understanding of the clinical complexity of the patient population to base accurate value-based reimbursement. Medicaid agencies, commercial payers and Medicaid managed care organizations nationwide use 3M APR DRGs for risk adjustment, claims payment and as the basis for hospital quality measurement.

    More information is located on the DHW website.

    Publication Date: May 2021

  • Outline of Texas
    Texas: Value-Based Enrollment Incentive Program

    Meeting a statutory requirement to redesign their Medicaid managed care auto-enrollment system around quality of care, efficiency and effectiveness of service, the new Texas program phased in a value score to the auto-enrollment process for the STAR, STAR+PLUS, and STAR KIDs programs.

    Published by Texas Health and Human Services Commission, January 2021

    Read the report (PDF, 1118 KB).

Resources for health policy and research

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  • Close-up of peoples' hands pointing at a report print-out

    Medicaid hospital payment policy to improve value through directed payments: A proposed strategy

    This paper proposes a strategy for Medicaid agencies to simultaneously maintain the flow of federal funding to states and hospitals, improve patient outcomes, increase transparency, reward efficiency, and promote access to care.

    Read the report (PDF, 282 KB).

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Blogs and podcasts

Explore expert insights and discoveries at the intersection of data science and health care.

  • Look beyond pricing to understand health care value

    As policy leaders look to understand this new data, they should be asking for the whole picture—price and quality. They also need to ensure “apples to apples” comparisons that reflect clinically similar patients.

  • Medicaid: The backbone of the U.S. health care

    As the largest health insurance program in the country, providing the majority of mental health care and long-term services and support, Medicaid is an indispensable component of the U.S. healthcare system. Matt Salo, Executive Director of the National Association of Medicaid Directors, works with state Medicaid agencies around the nation to improve quality, cost and the experience of care for patient populations that are most vulnerable.

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