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There is no question that states are working hard to get better value for their Medicaid dollar by implementing various quality initiatives with an eye toward reducing long-term costs. "They are constantly trying to work on program integrity issues. But the problem with some of the quality things, in particular, is that it's hard to see overnight savings," says Robin Rudowitz, a principal policy analyst for the Kaiser Commission on Medicaid and the Uninsured in Washington, DC. "States are still implementing those things.

Is 'doing business differently' enough to help cash flow?