High-performing health systems have succeeded in “breaking even” in Medicare, but many continue to struggle to achieve similar results in Medicaid. A concerted effort to improve revenue can strengthen a system’s financial sustainability.
Economic ebbs and flows are called “cycles” for a reason. The challenge for healthcare leaders is not whether the next downturn will occur—it’s whether you’re ready for it.
Addressing the social determinants of health: Capturing improved health outcomes and ROI for state Medicaid programs
The social determinants of health (SDoH) strongly contribute to variations in health status. Addressing SDoH can help ensure access to high-quality care, improve outcomes, and manage costs.
Survey findings shed light on how social determinants of health affect healthcare utilization rates and consumers interest in social program offerings.
Value networks and value-based payment are usually implemented independently, limiting their effectiveness. Greater alignment of these strategies can allow payers to unlock their transformative potential.
The Medicaid program has experienced significant changes since 2010, when the Affordable Care Act was passed. Five trends are likely to affect how the program will change over the next five to ten years.
Patterns in how consumers move in and out of Medicaid and Individual market coverage have important implications for both private- and public-sector stakeholders.
Healthcare is a dynamic industry with significant opportunity, but cost concerns, uncertainty, and complexity can also make it an unnerving one. Substantial upside exists for players that can deliver value-creating solutions and thrive under uncertainty.
Medicaid’s scale and complexity are unprecedented. State Medicaid leaders will need to innovate if they are to develop the capabilities that will enable them to steer their agencies into the future.
Ken Burdick, CEO, WellCare shares his perspective on major trends and opportunities in US healthcare with David Nuzum, Senior Partner, McKinsey and Company.
As more data about individuals with special care needs becomes available, the latest innovations in data analytics can be used to transform care delivery for them in a financially sustainable way.
Despite present uncertainties, MCO leaders can still aspire to grow—and make decisions to support that aspiration. Our research shows that the key sources of growth for Medicaid MCOs are strategic, not operational.
Recent trends are affecting providers’ revenue cycles and altering how providers should manage those cycles. Basic RCM is no longer enough.
The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers navigate the changes ahead.
A new concept, organizational agility, can help healthcare companies adapt more quickly to changing customer needs, competitor responses, and regulatory guidelines—without requiring a full-scale restructuring.
This paper explores opportunities states could consider to improve their Medicaid programs, both to control spending and improve the program's performance.
In part I of this February 2017 conversation, Erica Coe and Stephanie Carlton of the McKinsey Center for US Health System Reform discuss this question with Thomas Barker, former General Counsel at the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, and Ken Choe, a former Deputy General Counsel and Counselor to the Office of Health Reform at HHS. Mr. Barker is now a partner and co-chair of the Healthcare Practice at Foley Hoag. Mr. Choe is now a partner at Hogan Lovells.
This new framework can help states improve their ability to design and contract for managed Medicaid programs for these individuals—and maximize the programs’ likelihood of success.
The findings in this Intelligence Brief provide an introductory perspective on how the next US administration and Congressional Republicans may approach altering the ACA and related legislation. The information is based on publicly reported information released through December 8, 2016. Our Reform Center team is continuing to refresh this perspective on a real-time basis and is closely analyzing potential implications and economic impacts for each policy element under a full range of scenarios.
What states, private payors, providers, and technology companies are doing to control costs and improve outcomes for individuals with behavioral health conditions or in need of long-term services and support, including those with intellectual or developmental needs.
Eliminate fragmentation in the Medicaid delivery system, and you free up funds for other state spending priorities.
From 2012 to 2019, Medicaid enrollment is projected to grow by 9-15M lives (16-26%), and by the end of the period managed Medicaid is expected to cover ~80% of enrollees.
A new McKinsey survey offers payors, providers, and state governments a way to understand key differences among Medicaid consumers— differences that have important implications for how to engage current and potential enrollees effectively.
For most health systems, the one-time impact of expanded insurance coverage on utilization will be small but significant. Systems that can capture a substantial share of the increase in utilization may gain a competitive advantage.