search

The Impact of Quality Incentive Models in Medicaid Markets

  • December 18, 2019
  • 2:00 PM – 3:00 PM ET
  • online
about

41 of our 50 states now have Medicaid managed care, and several markets are expected to implement managed care in the next few years. More than $160B in Medicaid spending occurs through the Managed Care Organizations. As more and more states seek to do more with less, increasing accountability for health quality outcomes is placed on health plans. Most managed care states tie performance on key HEDIS measures to capitation incentives or withhold arrangements. Each state model is different in terms of the measures emphasized and the percent of capitation revenues at risk (ranging from 1-5%).

Attendees will learn:

  • Learn key insights about the different pay for quality models used in state Medicaid managed care programs
  • Understanding of how plans are looking to their revenue management organization to implement strategies and solutions
  • Identify emerging trends and upcoming changes to pay-for-quality models in major markets
  • Learn how to maximize the impact of a single in-home visit to address multiple care gaps, capture important risk adjusting diagnoses and enhance the individual care plan

Speakers 


Aerste Howells
Senior VP, Sales
Matrix Medical Network

As Senior Vice President, Sales, Ms. Aerste Howells is focused on the business, clinical and operational needs of health plans and providers. Through her leadership, Matrix is at the forefront of designing, developing and implementing innovative service solutions to meet those needs. Ms. Howells joined Matrix in 2011 as vice president, client services. Prior to joining Matrix, Ms. Howells was with Healthways, serving as director, account services, employer and government division where she was responsible for creating retention and expansion strategies for employer and government markets. Ms. Howells has a Bachelor of Arts degree in Marketing and Communications from Brigham Young University.


Clay Farris
Director of Operations
Mostly Medicaid

Mr. Farris has advised CMS administrators, state Medicaid Directors and a wide range of other clients in the healthcare industry. His experience includes policy making at both the federal and state levels, management consulting for large organizational change initiatives, big data solution sales and implementation and cutting-edge analytics. He currently serves as the Director of Operations for Mostly Medicaid, where he leads key project components related to consultation design, Medicaid subject matter expertise and project management. He has a Master’s Degree in Health Policy from the Johns Hopkins Bloomberg School of Public Health and is also a Certified Internal Auditor.

" "