Emerging Finance & Service Delivery Models

As selected by the OPEN MINDS Market Intelligence Team

  • The Merger Of Retail With Health Plans—Strategy, Please

    Executive Briefing | December 18, 2017
    Not all mergers are the same. We’ve seen the mergers of health systems like Advocate Health Care and Aurora Health Care, and Ascension Health and Providence St. Joseph Health (see Ascension & Providence St. Joseph In Talks To Form...
  • Why ‘Total Health Care’ For Individuals Is 2017’s Biggest Story

    Feature Article | December 15, 2017
    The biggest trend of 2017 is far from new, but the continued industry movement for providing “total health care” for individuals—including integration, community-based care, and long-term services and supports (LTSS)—as one of the prime industry stories of the year....
  • Why Specialty Care Coordination For I/DD & SMI Is 2017’s Biggest Story

    Feature Article | December 15, 2017
    As 2017 draws to a close, there has been a lot of talk on the OPEN MINDS team about “the biggest” health care stories and trends of the year—no small conversation considering health care is still in the grip of steady...
  • How Technology Is Changing Case Management

    Executive Briefing | November 14, 2017
    Targeted case management (TCM) has been a staple of services to consumers with complex conditions. The Centers for Medicare & Medicaid Services’ (CMS) definition for case management includes “services that assist eligible individuals to gain access to needed medical,...
  • Social Impact Bonds – Moving From Experimental To Scale

    Executive Briefing | July 21, 2017
    Of the many financing and financial diversification options that exist for provider organizations, the newest one to the table is pay-for-success (PFS) initiatives financed with social impact bonds (SIBs). We have been covering many recent PFS projects as they...
  • How The ‘Superutilizer Effect’ Has Driven Integrated Care & Changed The Mental Health Landscape

    Feature Article | May 23, 2017
    To discuss the “superutilizer effect” first you need to know what we mean when we say “superutilizer.” This cohort is the small percentage of the population that is responsible for the majority of health care spending, thanks in large...
  • Managed Care Comes To Social Services – Some Advice From The Field

    Executive Briefing | May 24, 2017
    Yesterday, my colleagues Monica E. Oss and Howard Shiffman looked at the continued expansion of managed care – this time to include children in the child welfare systems (see Ohio & Illinois The Latest To Link Child Welfare System...
  • Behavioral Health/Long-Term Care – A New Integration Frontier

    Executive Briefing | April 29, 2017
    As we move to more — and different — models for financing health and human services, new “integration” challenges are created. That was my first thought when I started paging through the report, Integrating Older Adult Behavioral Health Into...
  • Changing Financing Of Long-Term Services & Supports – A New Business Model In Its Wake

    Executive Briefing | March 4, 2017
    Last week’s edition of our news covered the contract awards for Medicaid long-term services and supports (LTSS) in Virginia – Virginia Awards Six Medicaid MLTSS Contracts For Commonwealth Coordinated Care Plus. On February 8, the Virginia Department of Medical...
  • State Medicaid Behavioral Health Carve-Outs: The OPEN MINDS 2017 Annual Update

    Market Intelligence Report | January 16, 2017
    Carve-outs are Medicaid managed care financing models where some portion of Medicaid benefits—dental services, pharmacy services, behavioral health services, etc.—are separately managed and/or financed. In Medicaid behavioral health financing arrangements, there are five main models that states use to...
  • How Prepared Are Health & Human Service Provider Organizations For Value-Based Reimbursement?

    Executive Briefing | March 12, 2016
    It’s coming. Over the past couple of months, we’ve covered how all payers are introducing many variants of value-based reimbursement – The Management Transition To Value-Based Reimbursement Is All About The Performance Metrics, Moving To Value – Easy To Say...
  • Moving To Value – Easy To Say & Hard To Do

    Executive Briefing | February 23, 2016
    Greetings from Washington, D.C. and the 2016 Legislative and Policy Conference of the National Association of County Behavioral Health & Development Disability Directors! Yesterday was a power-packed day – with deincarceration of county jails, the development of county-based certified...
  • Dual Eligible Demonstrations: Where Are We 4 Years Later?

    Executive Briefing | February 19, 2016
    The Centers for Medicare and Medicaid Services (CMS) began approving state dual eligible demonstration projects about four years ago, in 2012 – with the first state (Washington) launching its program in July 2013. There are currently nine states with...
  • Is Your Organization Ready To Be ‘The’ Care Coordinator?

    Executive Briefing | February 17, 2016
    The big push in health and human services is to find a provider organization to take on the responsibility for comprehensive care coordination for consumers including some degree of financial risk for the results in terms of consumer outcomes...
  • The Business Model Transition To Value-Based Care

    Executive Briefing | February 12, 2016
    Hello again from sunny Clearwater, where we are wrapping up The 2016 OPEN MINDS Performance Management Institute. It’s been a power-packed three days – with a focus on the evolution of pay-for-performance and value-based contracting. The discussion has left...
  • An Update On The State Medicaid Behavioral Health Carve-Out Landscape

    Executive Briefing | January 8, 2016
    As 2016 begins, we have decided to revisit the ever changing landscape of Medicaid health plan behavioral health carve-outs. There are two big changes in this space: The number of state Medicaid plans with the typical primary behavioral health...
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