"Carving Out" Conditions From Global Capitation Rates: Protecting High-Cost Patients, Physicians, and Health Plans in a Managed Care Environment

Supported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.

A private oncology shared savings plan reduced colon cancer treatment costs. Results varied by tumor, with none in breast cancer and mixed effects in lung cancer.

Accessing medical and social resources for patients, heavy administrative burden, and lack of data integration are barriers to Medicaid managed care organization care coordinators’ job performance.

Rural marketplace rating area change in Texas did not increase enrollment but increased share of enrollment in gold plans.

A large academic medical center implemented a charitable care formulary with clinical pharmacist oversight, which resulted in more efficient usage of funds and fewer readmissions.

Use of voluntary alignment attribution by Next Generation Accountable Care Organization (ACO) participants was limited. The authors highlight the reasons and describe organizational use cases via a mixed-methods approach.