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.
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.
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 (hawaii.gov)
Publication Date: July 2021
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
This biannual report from Texas Health and Human Services describes the agency’s efforts to reduce potentially preventable emergency department utilization by Medicaid recipients and current and proposed initiatives to improve Medicaid recipients’ health outcomes.
Published by Texas Health and Human Services Commission, March 2022
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State Medicaid agencies and health departments have a challenging job compounded in recent years with a global pandemic and changing payment models. With 3M’s unique background and more than 35 years of expertise, we can partner with you to ensure that your state not only meets budget and quality initiatives, but more importantly, enhances the lives of the people you serve.
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.
Mortality measures are intended to provide quality guidance for consumers and contribute to overall value-based purchasing (VBP) incentives for hospitals. In our study we look at the effect of the failure of the CMS mortality model to account for the effect on hospital performance rankings of variations in Do Not Resuscitate (DNR) orders and major comorbidities present at the time of admission (POA).
Why focus on health systems and MA? Two big reasons: its rapid growth and an increase in risk sharing arrangements between provider organizations and MA plans. Instead of defaulting into Medicare fee for service, beneficiaries can pick an MA plan during open enrollment in the fall. The MA plan receives a monthly amount from the federal government for each enrollee from which providers are paid.
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.
As I hopped on an Amtrak train to go to a meeting (something I haven’t done in a long time!), I pulled out my laptop to start reading emails – and a Health Affairs blog titled “Building On The CMS Strategic Vision: Working Together For A Stronger Medicare” by Centers for Medicare & Medicaid (CMS) leaders Meena Seshamani, Elizabeth Fowler and Chiquita Brooks La-Sure grabbed my attention and fueled my excitement about the future of health care policy and reform.
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