Managed Care & Value-Based Reimbursement

The impending shift to value-based reimbursement (VBR) and managed care in the health and human services industry has become a driving force across both public and private sector organizations, not only forcing new operating models and systems, but pushing providers to develop new partnerships with payers and to prepare for population health management. This shift presents organizational, technical, and cultural challenges that require a robust technology infrastructure, data-driven decisionmaking, and new leadership competencies. As behavioral health provider organizations move towards risk-based contracts, those who adapt to this change will have a better opportunity to carry forward in the provision of value-based services.

Latest Resources

• Blue Cross & Blue Shield Of North Carolina – Winning Proposal & Contract For Medicaid Children & Families Specialty Plan Services To North Carolina Department Of Health & Human Services, 2024
• 64% Of Health Care Organizations Expect Increased Value-Based Care Adoption
• The Medicaid Question
• Measuring Outcomes In Whole Person Care
• Another Step Forward
• Amerigroup DC Launches Medicaid Value-Based Agreement With DC Connected Care Network
• InHome Connect’s Data-Driven Palliative Care Model Reduced Hospitalization Rates By More Than 50%
• The Health Plan Imperative
• AMGA & Wilmington Health Launch AMGA Value Care Network To Advance Value-Based Care Nationwide
• AbsoluteCare & Aetna Better Health® Of Illinois Launch Comprehensive Value-Based Health Care Services In Chicago
• Aetna Health Plan – Winning Proposal For Dual Eligible Special Needs Plan (D-SNP) Services To Illinois Department Of Healthcare & Family Services, 2025
• Molina Healthcare Of Illinois – Winning Proposal For Dual Eligible Special Needs Plan (D-SNP) Services To Illinois Department Of Healthcare & Family Services, 2025
• Meridian Health Plan of Illinois, Inc. – Winning Proposal For Dual Eligible Special Needs Plan (D-SNP) Services To Illinois Department Of Healthcare & Family Services, 2025
• Three California Health Plans Unite On Multi-Plan Value-Based Health Care
• Molina Healthcare Of Wisconsin, Inc. – Winning Contract (Family Care Partnership) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025

Arizona Medicaid Contract For Elderly/Disabled Members Changed After Protest

On May 2, 2025, the Arizona Health Care Cost Containment System (AHCCCS) announced it had entered a settlement agreement and awarded four contracts for the Arizona Long Term Care System-Elderly and/or Physically Disabled (ALTCS-EPD) program. The settlement agreement resolves a procurement protest. The awardees are Arizona Physicians IPA, Inc. (dba UnitedHealthcare Community Plan); Banner-University Care Advantage (dba Banner-University Family Care); Mercy Care, and Bridgeway Health Solutions of Arizona, Inc. (dba Arizona Complete Health-Long Term Care).… Read

• Independent Care Health Plan (iCare) – Winning Contract (Family Care Partnership) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Inclusa, Inc. – Winning Contract (Family Care) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Molina Healthcare Of Wisconsin, Inc. – Winning Contract (Family Care) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Lakeland Care, Inc. – Winning Contract (Family Care) For Managed Care Organizations For The Delivery Of Managed Long-Term Care In GSR 5 To Wisconsin Department Of Health Services, Division Of Medicaid Services, 2025
• Aledade Expands Humana Value-Based Care Agreement To Serve FQHCs & Rural Health Clinics

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