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Welcome to the OPEN MINDS Circle library! For over 30 years, our team has covered the news, trends, metrics, regulatory changes, and thought leaders shaping the sectors of the health and human service field that affect consumers with chronic conditions and complex support needs. This is your gateway to this $860 billion market — all the information your team needs to stay on top of the market, make strategic decisions, and manage highly effective organizations.


Executive Briefing |

From Fee-For-Service To Episode-Based Payments: The Shift Continues

By Monica E. Oss

As the prolonged pandemic continues, every executive in every industry is asking the question, “what’s next?” The health care sector has been completely upended by the pandemic crisis. From our analysis, it appears that the “next normal” holds more focus on “whole person” health management models, “hybrid” service programs with a mix of telehealth and face-to-face services, more leverage of technology, and more focus on value (see my recent presentation, Navigating From Challenge To Opportunity: The Best Of The 2020 OPEN MINDS Management Best Practices Institute). That last piece—the focus on value—will be a move away from fee-for-service (FFS) reimbursement to some type of non-FFS alternative payment methodology (APM): bundled rates, case rates, episodic payments, and capitation reimbursement. I’m not certain what exactly that will look like and there will likely be significant variance by payer, consumer typology, and service models. Skeptics will say that we’ve been inching toward widespread acceptance of value-based reimbursement (VBR)...


Currently, there are 27 Medicaid managed long-term services and supports (MLTSS) programs operating in 24 states – Arizona, Arkansas, California, Delaware, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, and Wisconsin. The remaining 28 states, and District of Columbia, do not operate a...
Adults with low educational attainment (high school diploma or less) have higher rates of disability than adults with higher educational attainment due the higher prevalence of obesity and smoking, and to injuries from physically demanding occupations. These three factors are responsible for about half of the disparity in disability incidence between adults with low educational attainment and those with...

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