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The Anthem Public Policy Institute was established to share data and insights to inform public policy and shape the health care programs of the future. The Public Policy Institute strives to be an objective and credible contributor to health care innovation and transformation through publication of policy-relevant data analysis, timely research, and insights from Anthem’s innovative programs.

New Research

Understanding the Medicare Advantage Program

November 2017

Nearly one-third of Medicare beneficiaries are enrolled in Medicare Advantage (MA)—private plans that offer an alternative to traditional Medicare fee-for-service (FFS). A new paper from the Anthem Public Policy Institute offers an overview of MA, including how MA plans differ from the FFS model; how plan payments and risk adjustment work; and how MA plans work with providers to deliver value and quality to their members. For instance, unlike FFS, MA plans have robust care management and care coordination programs, out-of-pocket cost protections, and supplemental benefits. MA plans also support the long term viability of the Medicare program overall; MA has “spillover” effects onto traditional Medicare that lead to improvements in service utilization and lower costs for the program. In addition to the full paper, below is a link to a shorter issue brief that focuses on MA plan payments.

The Value of Coordinating Medicaid Services and Supports through a Health Home Approach for Children on the Autism Spectrum

October 2017

Medicaid managed care is turning towards new and innovative practices and approaches to meet the health and supportive service needs of children on the autism spectrum and their families. These efforts seek to seamlessly connect children to an array of services and supports that are tailored to the children’s and families’ preferences, needs, and goals. One of the emerging approaches is a health home designed specifically to support children on the autism spectrum. A new paper from the Anthem Public Policy Institute (PPI) demonstrates the important role health homes can play in serving children and youth on the autism spectrum. In partnership with MCOs, health homes can enhance the experience of children and their families by improving coordination, implementing a child- and family-centered approach, and offering critical assistance to children and their families as they navigate multiple agencies and delivery systems.

New Analysis Demonstrates Value of Chronic Condition Special Needs Plans

October 2017

As policymakers debate reauthorization of Medicare Advantage (MA) special needs plans (SNPs), a new analysis from Avalere Health, sponsored by Anthem’s Public Policy Institute, highlights how these specialized plans can improve outcomes and care utilization for their enrollees relative to other Medicare plans. The analysis, which focuses on chronic condition SNPs (C-SNPs), found that MA beneficiaries with diabetes enrolled in a diabetes-focused C-SNP are more likely to receive primary care services, less likely to use inpatient care, and more likely to be adherent to their antidiabetic medications and receive diabetes specific testing than beneficiaries enrolled in non-SNP plans. This new analysis offers insight into the value that C-SNPs, with models of care and programs tailored to focus on specific chronic conditions, can provide for Medicare beneficiaries with those chronic conditions.

Medicaid Managed Care Delivers Value and Efficiency to States

June 2017

State and federal policymakers are considering a variety of approaches to reform and modernize the Medicaid program. As these discussions take place, it is important to understand how state Medicaid programs have already achieved value-driven and cost-effective programs, including through the adoption of managed care. This paper from the Anthem Public Policy Institute presents findings from the literature demonstrating the impact of risk-based managed care on improving quality, managing costs, and enhancing the overall member experience. The data show that Medicaid managed care offers a successful foundation on which to build Medicaid reform efforts.

Coordinating Long-Term Services and Supports for Individuals Enrolled in Medicaid

May 2017

Given the significant role that Medicaid plays in the financing and delivery of long-term services and supports (LTSS), states are focused on improving the delivery of LTSS in ways that help Medicaid beneficiaries remain in their homes, live independently, and engage meaningfully in their communities. Managed care organizations (MCOs) are valuable partners to states as they seek to achieve these goals. More and more, states are moving to managed LTSS (MLTSS) arrangements in Medicaid. A new paper from Anthem’s Public Policy Institute examines the value of MLTSS for five groups who commonly use these services and supports: older adults (age 65+); adults with physical disabilities; individuals with specialty behavioral health needs; individuals with intellectual and/or developmental disabilities; and children who are medically fragile. In addition to the comprehensive discussion in the white paper, five summary documents underscore the benefits of MLTSS for each of the groups highlighted in the paper.

Integrating Care for Dual Eligibles: The Role of Medicare Advantage Special Needs Plans

March 2017

States are increasingly looking to Medicare Advantage dual eligible special needs plans (D-SNPs) as a partner in better integrating benefits and improving care for beneficiaries who are eligible for both Medicare and Medicaid benefits, also known as “dual eligibles.” A new paper from Anthem’s Public Policy Institute examines the role of D-SNPs in improving care delivery and health outcomes for these individuals. Drawing from interviews with current and former state Medicaid program staff in states that have used D-SNPs to increase care integration, as well as policy experts in this area, this paper describes the benefits D-SNPs offer and highlights key takeaways for successful partnerships with D-SNPs to advance states’ integration efforts.

Integrating Care for Medicaid Members with Mental Health Conditions and/or Substance Use Disorders 

December 2016
One in five Medicaid beneficiaries has a mental health condition and/or substance use disorder, and 60 percent of those individuals also have chronic physical health conditions. But owing to the traditionally siloed delivery of and payment for physical health, mental health, and substance use disorder care and services, Medicaid beneficiaries have too often received fragmented, uncoordinated care, leading to poorer health outcomes and higher costs. Medicaid managed care organizations (MCOs) are uniquely positioned to support the delivery of more holistic, coordinated care. Four new white papers from the Anthem Public Policy Institute examine approaches to and benefits from integration of physical health, mental health, and substance use disorder benefits as well as related areas of MCO innovation including connecting members to social supports, promoting effective information sharing, and increasing adoption of value-based payment models. 

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