Mark E. Lutes, Chair of the firm’s Board of Directors and a Member of the Firm in the Health Care and Life Sciences Practice, in the firm’s Washington, DC, office, was featured in MCOL ThoughtLeaders and discussed the question: “What are the implications for stakeholders as the share of national enrollment in Medicaid continues to increase in comparison to Medicare and commercial enrollment?”
Following is an excerpt:
Thus, the direct implication is pressure to move from operation as a volume driven service provider to situations, risk assumption (direct or through payor alignment) that allow the Medicaid book, when successfully managed, to contribute more to margin. As has been widely acknowledged, with these populations, behavioral health management, diet, fitness and social aspects of care management are crucial. Therefore, providers lacking capabilities in these areas will be working hard to build them so that their risk assumption (at any level) can be successful.