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Research and Policy Papers

Anthem experts are actively engaged in researching and analyzing critical data and information to better understand the impact of policies and programs for health care consumers and providers. Our experts have developed research and policy papers that help share our findings and insights.

Coordinating Long-Term Services and Supports for Individuals Enrolled in Medicaid

May – 2017

Given the significant role that Medicaid plays in the financing and delivery of long-term services and supports (LTSS), states are focused on improving the delivery of LTSS in ways that help Medicaid beneficiaries remain in their homes, live independently, and engage meaningfully in their communities. Managed care organizations (MCOs) are valuable partners to states as they seek to achieve these goals. More and more, states are moving to managed LTSS (MLTSS) arrangements in Medicaid. A new paper from Anthem’s Public Policy Institute examines the value of MLTSS for five groups who commonly use these services and supports: older adults (age 65+); adults with physical disabilities; individuals with specialty behavioral health needs; individuals with intellectual and/or developmental disabilities; and children who are medically fragile. In addition to the comprehensive discussion in the white paper, five summary documents underscore the benefits of MLTSS for each of the groups highlighted in the paper.

Integrating Care for Dual Eligibles: The Role of Medicare Advantage Special Needs Plans

March – 2017

States are increasingly looking to Medicare Advantage dual eligible special needs plans (D-SNPs) as a partner in better integrating benefits and improving care for beneficiaries who are eligible for both Medicare and Medicaid benefits, also known as “dual eligibles.” A new paper from Anthem’s Public Policy Institute examines the role of D-SNPs in improving care delivery and health outcomes for these individuals. Drawing from interviews with current and former state Medicaid program staff in states that have used D-SNPs to increase care integration, as well as policy experts in this area, this paper describes the benefits can D-SNPs offer and highlights key takeaways for successful partnerships with D-SNPs to advance states’ integration efforts.

Integrating Care for Medicaid Members with Mental Health Conditions and/or Substance Use Disorders 

Dec - 2016
 
One in five Medicaid beneficiaries has a mental health condition and/or substance use disorder, and 60 percent of those individuals also have chronic physical health conditions. But owing to the traditionally siloed delivery of and payment for physical health, mental health, and substance use disorder care and services, Medicaid beneficiaries have too often received fragmented, uncoordinated care, leading to poorer health outcomes and higher costs. Medicaid managed care organizations (MCOs) are uniquely positioned to support the delivery of more holistic, coordinated care. Four new white papers from the Anthem Public Policy Institute examine approaches to and benefits from integration of physical health, mental health, and substance use disorder benefits as well as related areas of MCO innovation including connecting members to social supports, promoting effective information sharing, and increasing adoption of value-based payment models. 

Key Considerations for Transforming Quality Measurement and Reporting in Medicaid Managed Care

Nov - 2016

Quality measurement for Medicaid managed care organizations (MCOs) is at a crossroads. To date, states have had tremendous flexibility to design their quality measurement systems, including selecting metrics and setting benchmarks for MCOs’ performance that align with states’ priorities. But new federal regulations released by the Centers for Medicare & Medicaid Services (CMS) in April 2016 will impose greater consistency, requiring all states to develop a quality rating system that draws from a core set of measures and common methodology. Three new papers from the Anthem Public Policy Institute set out to examine the impact that quality rating systems have on individuals, health plans, and providers as well as highlight several areas for consideration on the future of quality rating systems.

Enhanced Consumer Engagement and Decision-Making Are Driving Better Health

July - 2016

Following the passage of the Affordable Care Act (ACA), states have taken different approaches to Medicaid reform and expansion. One state pursued Medicaid reform under its state-specific model by incorporating unique aspects such as personal responsibility and building on the success of its pre-ACA model. The Medicaid model uses program and benefit design, along with both financial and non-financial incentives, to drive consumer engagement and decision-making. A new white paper from Anthem's Public Policy Institute details promising initial results from this new model in Medicaid.

 

Early Results from the Enhanced Personal Health Care Program: Learning for the Movement to Value-Based Payment

Mar - 2016

The Enhanced Personal Health Care program was created to build upon the success of patient-centered and value-based care, which research has shown is capable of delivering higher quality and more affordable care for patients. A new report from the Anthem Public Policy Institute shares the company’s learnings from the early stages of this effort which includes partnerships with 54,000 providers serving more than 4.6 million patients as of the end of 2015.

Hidden Benefits: The Value of Medicaid Managed Care

Sept -  2015

As states increasingly look to risk-based managed care to serve the majority of Medicaid beneficiaries, they are also looking for new and innovative ways to ensure that beneficiaries have access to the full array of services needed to keep them healthy. Traditional measures of “network adequacy” – including physician-to-enrollee ratios and time/distance requirements – are important, but they paint an incomplete picture of how Medicaid managed care plans, working with their provider and state partners, enhance network access and delivery of high quality care for their members through innovative network-enhancing strategies.

 

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