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Payer and Finance Models

Payer and Finance Models | 17 Articles

Can California's CalAIM Medicaid Transformation Initiative Achieve Systems Integration? Identifying Key Facilitators of Cross-Sectoral Coordination for Individuals with Complex Needs or at High Risk

This study, funded as part of the Robert Wood Johnson Foundation’s Systems for Action research program, evaluates the effectiveness of California’s CalAIM Medicaid Waiver program in integrating social service and public health organizations into Medicaid coordinated systems of care for individuals with complex health and social needs. CalAIM is designed to dismantle forms of structural racism by investing nearly $2 Billion in helping Medicaid health plans and medical providers forge stronger alliances with local social service organizations and public health agencies in addressing the complex health and social needs of Medicaid beneficiaries, including paying for nonmedical services needed by these beneficiaries.

An Aligned Delivery and Financing Model to Address Food Insecurity and Social Needs of Low-Income Pregnant Women

This study evaluates the effectiveness of an aligned service delivery and financing model designed to improve maternal and infant health by helping Medicaid-eligible persons receive access to healthy foods during pregnancy. The Nourishing Tomorrow (formerly Nourishing Beginnings) program uses integrated data, screening and referral systems combined with community health worker support to link people in need with healthy food delivery from a local food bank or with direct cash assistance for food purchases.

Integrating Health and Social Services through a Novel Independent Practice Association

This study investigates the impact of a novel independent practice association (IPA) formed among community-based social service organizations (CBOs) to address social determinants of health among residents of upstate New York. The Healthy Alliance IPA allows diverse CBOs offering services for housing, transportation, food, and other social needs to join together in a shared-governance association that facilitates referrals, care coordination, and performance-based contracting with health plans and medical providers.

Social Bonds as a Pooled Financing Mechanism to Address Social Drivers of Health Equity

This study investigates whether a novel type of social bond can pool resources across multiple competing health plans and create stable, long-term financing for interventions that address social determinants of health. The bond's design would allow multiple health plans participating in Minnesota’s Medicaid program to invest collectively in a fund that finances community-based interventions targeting social issues such as food insecurity, housing instability, transportation, and structural racism.