AHA Knowledge Exchange
Gain insights from the C-suite and health care leaders on the most pressing issues: navigating a changing landscape; fostering a culture of innovation; building health care’s workforce of the future; accelerating the shift to digital transformation; and leading for equity and resolving disparities.
Newest Knowledge Exchange
Managed Medicaid: Ensuring Quality Health Care Delivery
Data-driven strategies to combat MCO denial tactics
As Medicaid managed care enrollment continues to grow, Medicaid managed care organizations (MCOs) play an important role in ensuring that people with Medicaid coverage have access to medically necessary, covered services. The high number and rate of prior authorization delays and denials of care by some MCOs, the limited state oversight of Medicaid MCOs and the limited access to external medical reviews were concerns raised in the July 2023 Department of Health and Human Services Office of Inspector General report. This Knowledge Exchange explores avenues for accountability to require more transparency and timeliness from payers for this vulnerable population to avoid dangerous delays in patient treatment and practices that may compromise access to care.
Latest AHA Knowledge Exchange
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