Pharmacy benefit manager reform within Medicaid Managed Care: The pursuit of a model that preserves the intent of the 340B program

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Ohio’s Dual Eligible Population: Effects of Program Design and Implementation on Care Management

MyCare Ohio is a prospective blended managed care payment model program tasked to provide comprehensive and coordinated care to Ohio residents who are dully eligible for Medicare and Medicaid. To understand the administration and day-to-day implementation of care management within MyCare Ohio, n=75 interviews with a total of n=331 personnel from Area Agencies on Aging, Managed Care Plans, and service providers were conducted. Interviews were audio recorded, transcribed, and checked for accuracy. Data were analyzed by iterative reviews and deductive coding in Dedoose. Respondents provided insights on how care management activities are affected by program design features (e.g., ability to opt-out of the Medicare component), transitions between acute and long-term care settings, documentation systems and data-sharing, and high numbers of beneficiaries with behavioral health diagnoses. Implications for practice and policy will be discussed.

Managed Long-Term Care Services: A Playbook Innovation or a Hail Mary?

The approach to providing long-term services and supports (LTSS) has changed dramatically over the last three decades in both the financing and delivery arenas. In the U.S., long-term strategies have varied by state in organizational structure, scope of delivery and administrative practices. In the past two decades an additional change has emerged with over half the states adopting some form of managed LTSS. This shift has deepened the divide in state approaches to LTSS system design and delivery. The shift to managed LTSS has been largely fueled by ideological expectations and concerns about growing Medicaid costs: Empirical research findings have played a minimal role. For example, the large CMS evaluation conducted in this area did not include Medicaid data or encounter data from the managed care plans as part of the study efforts. However, the managed LTSS experiment does create an opportunity to compare costs and outcomes of these different models of financing and delivery. This symposium will present preliminary evaluation findings from two states, Ohio and Pennsylvania, which are generating data to assess both the implementation and outcomes of these alternative LTSS models. To set the context an initial paper will discuss the expansion of managed LTSS programs across the nation and examine how these efforts compare to the development occurring in the European LTSS systems. The third presentation will discuss the results of the Community Catalyst dual eligibles’ managed care demonstration program monitoring project.