As of January 1, 2015 three states have mandated the use of episode-of-care payments (either with providers or managed care organizations (MCOs)) and many more states are, or are considering, mandating Medicaid MCOs to use alternatives to fee-for-service payment.
This Toolkit provides interested ACAP members with relevant information to implement an episode-of-care program and is meant to guide Medicaid plans with step-by-step instructions on what analyses should be conducted and what considerations and decisions need to be made
in order to begin a successful episode-of-care program. Information for this Toolkit was collected through three years of research with health plans and providers who have implemented or attempted to implement an episode-of-care program. We draw upon their successes and lessons learned to create these instructions.