Course
Medicaid and Value-Based Care
How value-based care works in the country's largest coverage program: managed care contracting, state directed payments, Section 1115 waivers, health-related social needs, and how state agencies buy value.
By the end of this course, you will be able to:
- Explain how Medicaid's federal-state structure and open-ended match shape its value-based options
- Describe how a state uses its managed care contracts to drive value through health plans
- Distinguish state directed payments that raise rates from those that reward value
- Identify which authority a given social-needs benefit relies on, and how stable that authority is
- Assess why churn, low payment rates, and safety-net dependence change value-based design in Medicaid
How Medicaid Works
Medicaid is a federal-state partnership run separately in every state. Who it covers, how it is financed, and why value-based care looks different here.
Medicaid Managed Care
Most beneficiaries get care through private plans the state pays a fixed rate. Why that makes the state-plan contract the central value-based lever.
Provider Payment and Directed Payments
Low base rates drive a huge and fast-growing apparatus of extra payments. What state directed payments are, and why most of the money raises rates rather than rewarding value.
Section 1115 Waivers
The widest door in Medicaid law. How states test delivery reform, coverage, and social-needs benefits, and why the landscape shifts with each administration.
Health-Related Social Needs
No payer has pushed housing and food into covered benefits like Medicaid. The two authorities that make it possible, and why delivery is the hard part.
How States Buy Value
Pulling the course together: the Medicaid agency as a purchaser, the measurement that lets it buy on quality, and an honest account of what works and what is hard.