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Could 2018 be the year of the Medicaid ACO?

by Jeff Burke, Senior Manager Deloitte Consulting LLP and Matt Siegel, Specialist Leader, Deloitte Consulting LLP

A constant among many Medicaid programs is concern over rising costs. This applies to the 32 states that expanded their programs under the Affordable Care Act (ACA), and those that didn’t. In response, a growing number of states are eyeing alternative payment models (APMs), which reward health care providers for the value they offer, rather than the number of tests and services they perform.

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Is Dr. Smith in my network? MA enrollees want directories they can count on

by Danielle Moon, Specialist Leader, Deloitte Consulting LLP

During the early part of the decade, I was at the US Center for Medicare and Medicaid Services (CMS) where I headed a group that oversaw the Medicare Advantage (MA) program. At the time, MA provider directories really weren’t on our radar. But these electronic directories have come under scrutiny recently, and CMS is now conducting audits to help ensure the information is up to date and correct.

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Disrupting the social determinants of health: From exponential medicine to exponential health

by Josh Lee, Principal | Life Sciences & Health Care, Deloitte Consulting LLP

The year was 1989. I was an undergrad at Columbia University. I had a lot more hair than I do now and odd glasses – which by the way are now back in style. Seinfeld made its big debut on television and the Berlin Wall came down.

New York City had been experiencing a crisis throughout the 70s and 80s and there was a full-fledged epidemic of homelessness.

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By 2025, costs, regs, changing payer mix will help drive innovative partnerships

by James Whisler, Principal, Deloitte Consulting LLP

The health care system is on the cusp of rapid change, which is being driven largely by health care affordability issues. The prohibitive cost of health insurance is causing access issues, and continued large premium increases are likely unsustainable. The premiums are expensive because the medical costs are expensive. And along with higher premiums, out-of-pocket costs for consumers have climbed to historic highs.

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Experiments with Medicaid work requirements could create opportunities, administrative hurdles for health plans

by Jim Hardy, Specialist Leader, State Health Transformation Services, Deloitte Consulting LLP

You probably won’t find many glass beakers, test tubes, or Bunsen burners within the offices of state lawmakers, but that doesn’t mean there isn’t a good bit of experimentation being discussed within these “laboratories of democracy.” The concept of states as laboratories goes back to the early part of the 20th century when Supreme Court Justice Louis Brandeis used it to describe how a state could “if its citizens choose,

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