Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: A discussion of the impact of the June, 2012 U.S. Supreme Court decision on Medicaid expansion and the financial impications for states.

Description: Comparison of Healthy Michigan and Healthy Indiana Plan Medicaid expansion programs.

Description: This session is about the details of the inception and implementation of the Oregon Health Plan. From Record of Society of Actuaries Vol. 18, No. 1B.

Description: Beneficiaries who are eligible for both Medicare and Medicaid often have complex health needs. The two programs have not typically been well integrated and care can become uncoordinated, fragmented and incomplete. The ACA includes provisions to address the shortcomings.

Description: An edited written interview with two actuaries and a public health professional on issues related to the intersection between the two fields.

Description: COVID-19 is causing changes to nursing homes that will last beyond the pandemic. Nursing homes serve Medicare and Medicaid beneficiaries; so, in the public interest, we should consider how changes to nursing homes might impact these populations.

Description: This article discusses some of the most important considerations in implementing risk adjustment within a Medicaid Managed Care program. From Health Watch, January 2008, No. 57.

Description: Member benefit newsletter for the Social Insurance and Public Finance Section of the SOA.