Managed care involves a healthcare delivery system that encompasses care, services, and payment and seeks to control costs and enhance quality through the establishment of provider networks and employment of utilization management strategies.

This module consists of four components:

Medicare Advantage/Provider-led Special Needs Plans (SNPs) Webinar: 48 minutes

Provides an overview of Medicare Advantage/ Provider-led SNPs, explains how it works, and discusses the implications for LTC and PAC providers.

Provider-Led Special Needs Plans Case Study Analysis and Report: Twenty-six pages, pdf

An Idea That’s Growing: Long-Term Care Providers Taking Charge in Managed Care 

• Provides the results of the analysis of Medicare Advantage data on provider-led plans 
• Provides a summary of findings on case studies of three provider-led plans including key themes 
• Offers a six-component framework for successful operation of an LTC provider-led I-SNP including critical competencies and challenges 
• Advances policy implications and considerations

Medicare Advantage Brief: Two pages, pdf

Provides a high level overview of Medicare Advantage (MA) including MA growth, opportunities for value based contracts under MA, supplemental benefits and types of MA plans. 

Medicaid Managed Long Term Services & Supports (MLTSS) Brief: Two pages, pdf

States are shifting away from traditional fee-for-service Medicaid, often using § 1115 waivers to provide capitated MLTSS programs in efforts to streamline program administration, improve care coordination, and expand access to home and community-based services (HCBS).

This brief covers:

• The Basics of MLTSS
• Opportunities in MLTSS
• Optimizing MLTSS in Your State

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All Managed Care materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.