Module 6
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.
By the end of this module, you will be able to:
- Explain why procurement is a Medicaid agency's strongest lever over value
- Describe what a state quality strategy and mandatory Core Set reporting require
- Assess Medicaid value-based results against the constraints the program actually operates under
- The Agency as Purchaser A Medicaid agency's real power is as a buyer. This lesson shows how procurement, and re-procurement, is where value gets bought. About 4 min
- Quality Strategy and Measurement A state cannot buy value it does not measure. This lesson covers the required quality strategy and the newly mandatory Medicaid quality measures. About 5 min
- What Works and What Is Hard An honest close to the course: where Medicaid value-based care has shown promise, where it struggles, and what to watch. About 4 min
Module quiz
Answer all questions to see your score.
1. When does a managed care state have the most leverage to raise its value-based expectations?
Re-procurement is the leverage moment: to win the business, plans must meet whatever the new request for proposals demands.
2. What changed for Medicaid quality measurement in 2024?
Under the SUPPORT Act, these measures became mandatory beginning in FFY 2024, making a national comparison of Medicaid quality possible for the first time.
3. What is the most distinctive structural drag on value-based returns in Medicaid?
Frequent eligibility changes cycle members on and off coverage, undercutting the horizon over which prevention and care management pay off.