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By Athena Mandros

When we look at what topics our members are most interested in, the topics of money, Medicaid, and culture most often top the list. That was no exception when we looked at the most-read market intelligence reports from this past year. Our analysis of state Medicaid plans topped the list—along with spending on social impact bonds, the FDA pipeline, and the supply of psychiatrists. If you missed these reports, first check out my recent piece, Why You Need (Or At Least Shouldn’t Ignore) Market Intelligence. And then, read what your competitors have been using this past year to design their strategies for success.

State Medicaid Behavioral Health Carve-Outs: The OPEN MINDS 2018 Annual Update

A carve-out is a Medicaid managed care financing model where some portion of Medicaid benefits—dental services, pharmacy services, behavioral health services, etc.—are separately managed and/or financed. When considering Medicaid behavioral health financing arrangements, there are five main models that states …

The Changing Medicaid Carve-Out Market: The 2018 OPEN MINDS Update On Vertical Carve-Outs

The vertical carve out is a Medicaid financing model where some portion of the population receives services through separate managed care organizations that are at-risk for a continuum of physical and behavioral health services and pharmacy services. The populations served by this model are those with complex needs who can …

The 2018 OPEN MINDS Medicaid ACO Trend Update

Accountable care organizations (ACOs) are groups of health care professionals and/or provider organizations, such as physicians and hospital systems, that form an agreement to coordinate care for a set group of consumers. If the ACO delivers high quality care, measured through performance metrics, and lowers the cost of providing care against a baseline …

The 2018 OPEN MINDS State-By-State Guide To Estimating The Number Of Psychiatrists

Psychiatrists play an important role in the mental health care treatment continuum, primarily providing biological and somatic approaches to treatment such as prescribing antipsychotics or proving electroconvulsive therapy. This focus on biological and somatic approaches to mental illness is largely a result of a shortage of health …

The 2018 OPEN MINDS Medicare ACO Update: A Four-Year Trends Report

Accountable care organizations (ACOs) were originally developed as a Medicare construct as part of the Patient Protection and Affordable Care Act (PPACA) to improve care coordination and lower the cost of care. At this time, four Medicare ACO models have been developed: the Medicare Shared Savings Program, the Pioneer …

The FDA Pipeline For Medications For Behavioral & Cognitive Conditions: A 2018 OPEN MINDS Update

Medications are an increasingly important part of the management of chronic conditions. In 2016, prescription drug spending totaled $328.6 billion or 9.8% of the $3.3 trillion in health care spending. Comparatively in 2010, spending on prescription drugs total $253.1 billion or 9.7% of the $2.6 trillion in health care spending. For consumers …

Medicare-Medicaid Dual Eligible 2018 Market Update: Enrollment & Coverage

Dual eligibles are consumers who—due to disability, age, and/or income—are eligible to enroll in both Medicare and Medicaid. Because dual eligibles are enrolled in both Medicaid and Medicare, they receive health care services through two separate financing and delivery systems. This makes both integrating and coordinating …

2018 Spending Trends For The Medicaid-Medicare Dual Eligible Population: An OPEN MINDS Market Intelligence Report

Dual eligibles, who are sometimes referred to as Medicare-Medicaid enrollees, are consumers that—due to disability, age, and/or income—are eligible to enroll in both Medicare and Medicaid. There are two main types of dual eligibles: full-benefit and partial-benefit. Like the name suggests, full-benefit dual eligibles are consumers who …

Social Impact Bonds: Over $166 million In Funding & 20 Programs: An OPEN MINDS Market Intelligence Report

Social impact bonds (also known as pay-for-success or social improvement bonds) are a new way of financing social services that focus on payment for outcomes rather than the volume of services delivered. Under the social impact bond model, private investors put up funding for a social services program, which the government pays …

Medicare Specialty Vertical Carve-Out Plans: The 2018 OPEN MINDS Medicare SNP Market Share Report

Created as part of the Medicare Modernization Act of 2003, Medicare Advantage special needs plans (SNPs) have been in operation since 2006. SNPs are a specific type of Medicare Advantage plan that serve Medicare beneficiaries with complex conditions and needs. Plans must offer the full-continuum of Medicare benefits …

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