September 17, 2025
Rural Health Transformation Program Represents a One-Time Opportunity to Reshape Rural Care
1314 Results found.
Webinar Replay- Beyond the Bill: How Pair Team and MCOs Are Meeting Community Needs Under HR 1
This webinar was held on October 2, 2025.
As Medicaid evolves under HR 1, Managed Care Organizations face increasing pressure to meet new engagement requirements while ensuring vulnerable communities don鈥檛 fall through the cracks. This shifting landscape demands scalable, innovative care models that go beyond compliance 鈥� focusing instead on meaningful connections, coordinated support, and whole-person care.
In this session, Jami Snyder, former HHSC Commissioner of TX and Medicaid Director of AZ, joined Neil Batlivala, CEO and Co-Founder of Pair Team, and Dr. Nate Favini, Chief Medical & Strategy Officer, to explore how Pair Team and its MCO partners are meeting this moment. Learn how their model combines technology, care coordination, and community-based partnerships to engage hard-to-reach members and address social drivers of health.
We heard real-world examples of how payers and partners can come together in smarter, more connected ways. By aligning efforts and building trust, they can drive better outcomes and create stronger community connections for the people who need support the most.
Learning Objectives:
- Briefly break down HR 1鈥檚 most critical provisions and what they mean for Medicaid and MCO operations.
- Discover how Pair Team and MCOs are co-designing solutions leveraging technology.
- Identify best practices for engaging populations facing barriers such as behavioral health needs, housing instability, and transportation challenges.
Featured Speakers:
Carter Kimble, Principal (Moderator) Health Management Associate
Jami Snyder, Former HHSC Commissioner, Texas; Former Medicaid Director, Arizona
Neil Batlivala, Founder and Chief Executive Officer Pair Team
Nate Favini, MD,MS, Chief Medical Officer Pair Team
Building Bridges: Key Insights from the 2025 HCBS Conference and What They Mean for Your Organization
This week, our In Focus features insights from the team of 量子资源网 (量子资源网) experts who attended the . Over a handful of days, aging and disability leaders, state officials, health plans, providers, and advocates gathered to explore strategies to transform long-term services and supports. The event celebrated advances in cross-sector collaborations, evidence of program value, seamless access to care for older adults and people with disabilities, member engagement, and integrated care plans for dually eligible individuals.
量子资源网 participants identified seven cross-cutting themes that are reshaping the aging and disability landscape. We examine how these themes connect to ongoing federal policy changes and provide actionable guidance for stakeholders looking to stay ahead of the curve in this evolving field.
Key Cross-Cutting Themes from the Conference
Executive Leadership Is Making the Difference
State leaders are developing new partnerships to continue progress toward meeting the needs of people with disabilities and aging adults across the lifespan. The conference showcased the significant progress that states have made by engaging governors and cabinet-level leaders. Pennsylvania’s aging department, for example, though small, leverages lottery funding and executive support to coordinate across departments and various strategic planning initiatives such as their multisector plan for aging.
North Carolina鈥檚 policy leadership in the governor’s office has been instrumental in aligning aging goals across state agencies such as the Department of Commerce on workforce initiatives and Department of Transportation which includes specific older adult needs in its planning.
Tennessee exemplified this approach by merging its Commission on Aging and Disability with the Department of Intellectual and Developmental Disabilities to establish g.
This executive engagement enables what Kathy Greenlee, former ACL Administrator, emphasized: building partnerships beyond traditional aging and disability networks including connections with children and families programs that share common goals around caregiver support and prevention.
Technology Is Extending Human Capacity, Not Replacing It
Technology took centerstage as one of the major solutions to providing personalized caregiver supports and extending the capacity of human services. States are embracing AI (artificial intelligence)-powered tools for routine tasks like call transcription and resource database management, while maintaining human oversight for complex client interactions.
The most successful approaches recognize what highlighted, “High tech won’t replace the need for high touch, but high touch is in short supply.” Technology networks can stretch caregiver capacity, but the human element remains essential. The next generation of service professionals must be tech-savvy integrators who combine digital tools with caring relationships. Key technological advances include digital and virtual coaching platforms, AI precision analytics for risk identification, and “home intelligence” systems that support aging in place. Success, however, depends on ensuring these tools enhance rather than replace human connection.
Direct Care Workforce Crisis Demands Immediate Action
Leading states are not just attempting to manage workforce shortages; they are working on comprehensive workforce infrastructure solutions. Wisconsin’s Certified Direct Care Professional program enrolled over 3,400 workers in its first year, reduced turnover rates, and created a statewide registry where employers actively recruit graduates. Michigan developed four-level stackable credentials that transform direct care into respected career pathways.
States are deploying integrated workforce platforms that combine multiple solutions, including worker registries that promote workforce access and transparency, learning management systems that strengthen development through credentialing, and job matching that enhances access to quality care, and data insights that support evidence-based decisions.
Missouri demonstrates effective stakeholder engagement through its Direct Support Worker Advisory Panel, where 15 workers provide feedback on rates, documentation, scheduling, and professional development while being compensated in developing the solutions, for example, by including them in official advisory entities.
Forward-thinking organizations are breaking down silos through cross-sector partnerships. Area Agencies on Aging and Centers for Independent Living are cross-training workers to serve both populations, effectively expanding the available workforce capacity. Technology integration scales solutions through online, self-paced training that accommodates work schedules and diverse learning needs, while states use federal funding and Medicaid rate increases to boost wages and implement recognition strategies that elevate professional status.
Evidence-Based Investment Strategies
States shared the power of systematic, data-driven approaches to secure aging and disability investments. Ohio’s disciplined four-step process鈥攊dentify priorities, determine evidence-based interventions, quantify return on investment, and operationalize results鈥攔esulted in
Under this reframing, aging can now be seen as an opportunity rather than a burden. States are building ecosystems and partnerships to enhance reach and effectiveness. This positions aging investments as competing priorities capable of delivering measurable returns. with career ladder pathways exemplifies how evidence-based workforce strategies can address critical shortages while improving quality.
The Urban Institute’s research on benefit uptake reveals that nearly 9 million older adults are eligible for programs they don’t receive. Success factors include coordinated state agencies, streamlined applications, community trust-building, and staff training鈥攁ll areas where evidence-based approaches can guide improvement.
Holistic Support for Caregivers and Care Members
The conference emphasized a fundamental shift from viewing caregivers as invisible helpers to recognizing them as partners who require comprehensive support. Key elements for achieving caregiver-driven outcomes include providing support, guidance, and assistance while measuring burden, resilience, satisfaction, and finally, the intent to remain in home settings. , reflecting growing recognition of how caregiver skill-building adds value. This holistic approach extends to addressing the question of who replaces the family caregiver, as older adults increasingly live alone. The answers rest with the development of new partnerships with retailers, pharmaceutical companies, and employers, plus technology that enables remote family support.
Cross-Sector Collaborations: Systems Integration as Survival Strategy
Breaking down silos that have historically separated aging, disability, children and families, and health services resonated throughout the conference. Kentucky observed that states struggle with multiple uncoordinated plans, each with different goals and measures.
Several states have demonstrated successful integration strategies, such as aligning funding streams, creating shared governance structures, and using common metrics across traditionally separate systems. North Carolina’s approach of embedding aging considerations in transportation planning and commerce workforce development shows how integration can extend beyond human services.
From a federal perspective, integration has support. As Greenlee noted, the Administration for Children, Families, and Communities includes “communities” in its title as a signal of broader inclusion. States that build partnerships across these traditionally separate areas will be better positioned for future federal funding and policy changes.
MLTSS as a Critical Vehicle for Whole-Person Care
Managed Long-Term Services and Supports (MLTSS) programs are evolving an infrastructure for providing coordinated and integrated care delivery care. As this transformation occurs, states must have adequate oversight capacity to manage MLTSS programs effectively.
Effective MLTSS programs can help people early enough to prevent nursing facility placement by integrating all services including medical, behavioral, and HCBS and social supports through capitation. Plans should allocate resources to support provider technological investments that facilitate improved care coordination. This technological support becomes essential to maintaining the high-touch, personalized services that MLTSS members require while achieving the scale necessary for program sustainability.
Policy Connections: From Conference Themes to Federal Action
These conference themes reflect broader federal policy shifts, including:
- New funding must be used more strategically. The $10 billion annually for rural health transformation (2026鈥�2030) can also create opportunities to integrate aging services into the broader health infrastructure.
- Resource constraints sparks innovation. As the Administration for Community Living faces resource constraints with significant staff reductions, states must be more proactive and resourceful in developing innovative programs.
- Advocacy must be timed. Upcoming budget cycles require strategic timing for advocacy efforts.
The Road Ahead for Stakeholders
Organizations across the aging and disability ecosystem must prepare for a more integrated, technology-enhanced, and evidence-driven environment. Success will require executive leadership, strategic partnerships, and measurable value.
State Agencies
- Engage executive orders establishing aging as a priority across all state departments.
- Developing systematic evidence-based investment strategies that quantify return on investment for aging initiatives, using Ohio’s four-step methodology as a template.
- Building partnerships beyond traditional aging and disability networks, including with children and family services, workforce development, and transportation agencies.
- Implementing workforce development strategies that include investing in credentialing and tech-enabled training, and cross-sector partnerships to address to strengthen the direct care workforce.
Health Plans and Payers
- Implementing holistic caregiver support programs that combine digital tools with human coaching, measuring outcomes like burden reduction and care member satisfaction.
- Leveraging new Medicare coding opportunities for ADL/IADL supports to pay for evidence-based caregiver training and skill-building programs.
- Partnering with technology companies to deploy AI-powered risk identification tools while maintaining human oversight for member interactions.
- Investing in provider technology infrastructure that enables better care coordination and supports MLTSS program effectiveness.
Providers and Community Organizations
- Developing technology-enhanced service delivery that extends human capacity while preserving personal connection, following the “high tech, high touch” principle.
- Pursuing evidence-based training and credentialing programs with clear career pathways.
- Building partnerships with non-traditional allies like retailers, pharmaceutical companies, and employers to expand aging-in-place support networks.
- Participating in workforce development initiatives that create shared worker pools across aging and disability services.
Technology Vendors
- Developing AI-powered tools that enhance rather than replace human service delivery, focusing on routine tasks like documentation and risk assessment.
- Creating integrated platforms that support cross-system coordination between aging, disability, health, and family services.
- Building home intelligence systems that enable remote family caregiving and professional monitoring while preserving independence and dignity.
- Designing workforce development platforms that support credentialing, job matching, and career advancement tracking.
Moving Forward Together
The 2025 HCBS Conference revealed a field that is embracing innovation and integration. States leading this transformation share common characteristics: executive leadership, evidence-based investment strategies, technology that enhances human connection, holistic support approaches, and systems that collaborate to break down traditional silos.
The path forward requires strategic planning, rigorous evaluation, cross-sector partnerships, and sustained political will. Organizations that can integrate evidence-based approaches with compassionate care, leverage technology to extend human capacity, build partnerships that transcend traditional boundaries, and develop sustainable workforce solutions, will be best positioned to serve the growing population of older adults and people with disabilities.
Connect with Us
The HCBS Conference highlighted significant momentum toward integrated service delivery, evidence-based investment, and technology-enhanced care. Stakeholders should expect continued federal policy evolution, including new funding opportunities and partnership requirements in the coming years. Organizations that wait will miss critical opportunities. 量子资源网 works with state agencies, health plans, providers, and community organizations to design and implement aging and disability initiatives. We help clients engage executive leadership, develop evidence-based business cases, deploy appropriate technology solutions, build cross-sector partnerships, and create sustainable workforce development strategies. To discuss how these trends affect your organization and explore next steps, contact our featured experts below.
September 10, 2025
Building Bridges: Key Insights from the 2025 HCBS Conference and What They Mean for Your Organization
Understanding Substance Use Disorders & the Use of Medications for听Treatment
Education Materials for Patients, Families, Educators and Non-Prescribing Providers
This is a comprehensive set of substance use disorder听(SUD)听education materials for patients, families, educators, and non-prescribing providers.听In recognition of September being National Recovery Month, this document is fully downloadable for community use without restriction. 听听
The toolkit was made available through a joint effort of the California Department of Health Care Services Opioid Response Project and 量子资源网. Coaching and technical assistance for this project was funded through DHCS by State Opioid Response Funds from SAMHSA. The bilingual patient education materials are written in accessible language for most audiences, in both Spanish and English.
The materials can be used to broadly disseminate information across a community or with individual patients, family members and non-prescribing providers. These SUD educational materials were created using the latest research and information available. They are meant to be concrete and easily accessible with simple language that promotes increased understanding of each topic. Some of the topics touched upon include evidenced-based treatment options such as Medications for Addiction Treatment (MAT) and Medications for Opioid Use Disorder (MOUD).
Webinar Replay – Medicaid 1115 Justice Involved Reentry Demonstration Opportunities: Engaging Key Stakeholders
This webinar was held October 22, 2025.
This webinar explored how states, local agencies, and community organizations can maximize Medicaid鈥檚 new 1115 demonstration authority to improve reentry outcomes for justice-involved individuals. Presenters discussed practical strategies for assessing health and social needs, building strong collaborations with community providers, and implementing effective Medicaid enrollment processes. Attendees gained insights into designing and operationalizing reentry programs that promote continuity of care, reduce recidivism, and support successful community reintegration. This session is ideal for State Medicaid agencies, carceral facilities, correctional healthcare companies, health plans, community-based organizations, and federally qualified health centers.
Learning Objectives:
- Understand the health and resource needs of returning citizens (health, behavioral health and social issues).
- Identify key partners and formalize collaborations to strengthen the quality of transitions, care and support provided to individuals transitioning to the community.
- Develop Medicaid enrollment strategies that apply to your state and local framework.
From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems
量子资源网 Spotlight
From Crisis to Coordinated Care: Six Behavioral Health Priorities for Hospitals and Health Systems
Hospitals across the country are facing unprecedented levels of behavioral health (BH) challenges that impact every facet of operations, from the emergency department to discharge planning. Extended lengths of stay, ED boarding, workplace violence, and staff burnout present clinical issues and pose operational, financial, and reputational risks.
Individuals with BH needs arrive in emergency departments daily, even if the hospital lacks a dedicated BH inpatient unit. These patients require coordinated care across all clinical sites.
量子资源网 offers an end-to-end partnership helping hospitals identify and implement solutions in ways that build internal capacity and deliver measurable results.
Rapid assessments to identify high-impact opportunities
Financial modeling and reimbursement optimization
Strategic and operational planning for BH integration
Partnership development and M&A advisory for BH service lines
Implementation support with measurable results
Effective Strategies
量子资源网 partners with hospitals to address these challenges with a vision of improving care and operations. Our team offers practical, high-impact solutions that enhance patient care, support your workforce, streamline operations, and promote financial stability. Contact us to discuss how solutions can be tailored to your hospital鈥檚 unique needs. Let鈥檚 address your most urgent behavioral health challenges now, before they impact care delivery and financial stability.
Six Priority Areas
While every hospital faces unique behavioral health challenges, the pressures they create are consistent. 量子资源网 partners with your leadership and frontline teams to focus on six proven priority areas that create lasting impact. Together, we develop solutions that improve care, strengthen operations, and build resilience across your organization.
- Rapid stabilization protocols
- Integration of psychiatric expertise into acute care workflows
- Boarding reduction strategies
Value: Reduce length of stay, improve throughput, and protect staff safety.
- Cross-continuum care pathways
- Partnerships with community providers
- Readmission prevention frameworks
- Accreditation readiness (The Joint Commission, DNV (Det Norske Veritas))
Value: Improve continuity, patient satisfaction, and reduce high-cost utilization.
- Optimizing reimbursement (e.g., unbundled billing for injectables)
- Service line financial assessment
Value: Unlocking new revenue streams.
- Joint ventures with behavioral health providers
- Sell-side preparation and merger and acquisitions support
- Community and payer alignment
Value: Expand service capabilities while sharing risk and resources.
- Staffing models to provide effective and efficient care while reducing burnout
- Data-driven performance management
- Technology-enabled workflows
Value: Increase efficiency and retention through optimized operations.
- Medication Assisted Treatment (MAT) and Medication for Opioid Use Disorder (MOUD) implementation in ED and inpatient settings
- Peer navigation programs
- Integration with primary and specialty care
Value: Reduce mortality, avoidable readmissions to EDs, and improve community health outcomes.
Proven Results
Our work with hospitals across the country delivers measurable, lasting improvements that strengthen care delivery, operational performance, and financial health.
- Reduced ED boarding times by up to 40% through targeted intervention models.
- Increased reimbursement for behavioral health services by optimizing billing practices for long-acting injectables and other high-value services.
- Delivered $1.2M in annual savings for a regional hospital through integrated behavioral health response planning.
量子资源网 Differentiators
Many of our team members are former executives and clinical leaders from the behavioral health sector. They bring decades of experience leading behavioral health care in inpatient, outpatient and emergency department settings. 量子资源网 provides the depth, agility, and collaborative approach that hospitals need to address today鈥檚 most urgent behavioral health challenges while also building capacity for the future. Our proven track record includes hospitals of all sizes and structures, ensuring that solutions are tailored to your market, patient mix, and resources.
ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations
量子资源网 Spotlight
ABA Compliance and Strategic Policy Support for Medicaid Managed Care Organizations
Applied Behavior Analysis (ABA) is an evidence-based behavior therapy for people with autism spectrum disorder (ASD) and other developmental disorders. In recent years, the diagnosis of ASD and subsequent demand for ABA services has increased. State Medicaid administrations and Managed Care Organizations (MCOs) are tracking increased ABA utilization and wait times for these services, and in some situations are investigating quality of care and/or fraud, waste, and abuse (FWA) concerns. To optimize quality care for members, MCOs who cover these services must have policies regarding ABA benefit structure, clinical guidelines, utilization management, and service delivery. Plans also need to monitor for and identify possible FWA concerning documentation and/or billing practices for these services. MCOs with comprehensive ABA compliance and auditing programs can meet these critical needs.
Our team
量子资源网鈥檚 national presence keeps us at the forefront of ABA-related changes in multiple states. 量子资源网鈥檚 team of behavioral health clinicians have years of experience conducting FWA audits and have specific training required to conduct detailed and meticulous ABA reviews. Our team includes operational and clinical subject-matter experts with board certifications in behavior analysis (BCBA, RBT) who can support auditing activities as well as policy review and revision. We will work with your organization鈥檚 team to provide the insights necessary to maximize ABA quality of care and cost efficiency.
How 量子资源网 can help
We work closely with MCOs to develop a customized scope of services that meet their unique ABA compliance, policy, and strategy needs.
We can help MCOs with:
- Establishing their own ABA compliance programs
- Conducting audits of ABA provider claims and associated medical records, using customized audit tools and findings reports, to identify potential FWA, including as part of an MCO鈥檚 Special Investigation Unit (SIU) program
- Reviewing and providing feedback on ABA-related policies
- Developing ABA-related documentation forms
- Providing consultation on ABA reimbursement/utilization benchmark development
- Providing support in building cohesion/collaboration between MCO and local Department of Developmental Disabilities representatives
- Developing strategies to improve care coordination for youth transitioning to adulthood
- Assisting MCOs with their Managed Behavioral Healthcare Organizations (MBHO) benefit oversight
- Demonstrating how to maximize the interface of organizational Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefits and the intersection with ABA services
We produce results
Our auditing team members have supported the SIUs of three Medicaid health plans in different states. We have demonstrated a 12:1 return on investment for our clients, based on associated recoupment of improper payments and estimated prevented loss.
If you have questions about our ABA compliance, policy, or strategic support services, contact our experts below.
Contact our experts:
Nicole Lehman
Associate Principal
Nicole Lehman is an experienced healthcare professional specializing in the improvement, development, and growth of multifaceted, high-paced managed care organizations. … Read more
States Begin to Engage with the Rural Health Transformation Program
The Rural Health Transformation Program (RHTP) established in H.R. 1 represents one of the most significant federal investments in rural healthcare in decades. With $50 billion allocated between fiscal years 2026 and 2030, the program is designed to stabilize and transform rural health systems nationwide by supporting infrastructure, workforce development, and innovative care delivery models.
Administered by the Centers for Medicare & Medicaid Services (CMS), the RHTP requires each state to submit a one-time application detailing a comprehensive rural health transformation plan. These plans must address eight core priorities, including improving access and outcomes, leveraging technology, fostering regional partnerships, and ensuring long-term financial solvency for rural entities. The Centers for Medicare & Medicaid Services (CMS) has posted the , with application materials expected to become available in mid-September and state submissions due in late fall 2025.
The experts at 量子资源网, including our Information Services team (量子资源网IS), are tracking several state-level indicators and actions, including lead state agency points of contact, regulatory and public comment deadlines, and links to official notices. Following are the key takeaways from 量子资源网IS State Action Tracker鈥攁 living resource for 量子资源网IS subscribers, which will be updated with federal and state-level details such as state-selected RHTP categories and award amounts.
Initiative Alignment and Partner Engagement: Common Themes Across States
As of early September 2025, at least 15 states have begun structured intake to inform initiatives and uses of the RHTP funding鈥攔equests for information (RFIs), surveys, town halls, webinars鈥攚ith others maintaining a planning posture pending release of CMS鈥檚 application template.
Common themes and approaches emerging from these activities include:
- Category-aligned input.听States are encouraging stakeholders to align proposals with the statute鈥檚 eligible activities (e.g., access, outcomes, technology/prevention, partnerships, workforce, data/IT, solvency). Examples include:
- 听requires submissions to identify which of the nine categories are addressed and to discuss outcomes and sustainability.
- Delaware and听听use structured prompts to sort feedback by activity type.
- Pre-guidance tools.听States like听听听and听听are using RFIs and statewide surveys to gather ideas and identify viable projects before CMS guidance is finalized.
- Tech-enabled care.听New and expanded uses of technology are topics of interest to states that are seeking ideas on how to maximize investments in remote monitoring, artificial intelligence (AI)/robotics, data/analytics, and IT/cybersecurity as eligible investments for improving access to services, healthcare delivery, and workforce support. For example:
- 听explicitly references technology-enabled care models.
- 听and听听highlight health IT/cybersecurity and value-based purchasing.
- Local coordination.听States are encouraging regional partnerships/community hubs and rebalancing or right sizing service lines to match local demand.听听and听听emphasize right sizing service lines and coordinated care across the continuum of pre-hospital, emergency, acute inpatient, outpatient, and post-acute services.听听solicitation prioritizes regionally coordinated partnerships and explicitly calls out right sizing the care continuum as a focus area.听听highlights strengthening partnerships between rural hospitals and other providers as a required component of the state plan.
- Sustainability and value-based readiness.听States are asking how projects will be sustained after federal funding ends and how these can support and sustain alternative payment models.听听and听听request implementation details and financial durability plans.听听prompts discussion of how proposals enable care coordination and payment reform.
Looking Ahead
The emerging national landscape for RHTP initiatives is mixed. Early state movers and their engaged partners are building momentum and reducing execution risk, while others are preserving flexibility until additional federal guidance arrives. States waiting on CMS鈥檚 template may face challenges in coordinating stakeholders and finalizing priorities before the application deadline.
For providers and community-based organizations (CBOs), now is a critical time to engage. These organizations are uniquely positioned to shape state applications by sharing on-the-ground insights, identifying unmet needs, and proposing scalable, sustainable solutions. Participating in state RFIs, surveys, and town halls allow providers and CBOs to inform how funding is prioritized and deployed.
To prepare for the RHTP resources and support, healthcare organizations should:
- Monitor state-level engagement opportunities and respond to RFIs or surveys with clear, category-aligned proposals
- Build or strengthen partnerships with other local organizations to demonstrate regional coordination
- Assess internal capacity to implement and sustain projects beyond the federal funding window
- Document outcomes and financial models that support long-term viability and alignment with value-based care
Connect with Us
To support transparency during this fast-moving period, 量子资源网IS has launched the RHTP State Action Tracker, a centralized resource for curating each state鈥檚 actions, agency leads, deadlines, and links to official notices. The tracker will be updated as CMS guidance is released and as states fill in details, such as selected categories and award amounts. For details about the RHTP, including the 量子资源网IS State Action Tracker, contact 量子资源网 experts听below.
Webinar Replay – Beyond Bundles: Preparing Hospitals for Success in TEAM and the Next Generation of Value-Based Models
This webinar was held on September 30, 2025.
Hospitals and health systems are under growing pressure to succeed in new value-based models that demand both operational transformation and strategic alignment. In this webinar, advisors from 量子资源网, Wakely, an 量子资源网 Company and Nixon Peabody broke down the latest regulatory and contractual developments, explored lessons learned from the Comprehensive Care for Joint Replacement (CJR) model, and discussed how organizations can prepare for upcoming opportunities.
Speakers shared practical insights on:
- The regulatory, operational, and actuarial considerations hospitals must navigate
- Key takeaways from bundled payment initiatives like CJR
- How to leverage data and design strategies to build partnerships that position organizations for success in new Medicare models
This session was designed for hospital executives, provider organizations, payers, and policy leaders seeking to better understand how emerging value-based models will shape the future of care delivery and payment.
Featured Speaker:
Whitney Phelps, J.D., Partner Nixon Peabody
Webinar Replay – Navigating Medicaid Managed Care Shifts: Financial Pressures, Federal Policy, and Medicaid MCO Implications
This webinar was held on September 17, 2025.
Medicaid managed care organizations face mounting pressure as enrollment patterns shift, federal policy evolves, and state budgets tighten. In this webinar, experts from 量子资源网IS, Wakely, and 量子资源网 shared exclusive analysis of Medicaid Managed Care Organization (MCO) financial performance, explored the implications of HR 1 and other federal policies, and offered State and MCO perspectives.
Learning Objectives
- Interpret 2024 Medicaid MCO financial trends and historical benchmarks to anticipate future market performance.
- Assess how federal policy changes, including HR 1, are reshaping Medicaid enrollment and creating new fiscal pressures for States and MCOs.
- Evaluate state considerations around risk corridors, medical loss ratios (MLRs), and similar mechanisms in a challenging budget environment.
- Identify strategies and planning initiatives that promote resilience, sustainability, and adaptation for Medicaid managed care organizations in a shifting landscape.
This webinar was for Medicaid managed care leaders, state officials, vendors, budget officers, and investors navigating financial pressures and policy shifts.