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He also cautioned that it could not be the Payment Improvement Initiative itself that directly led to the slowed growth it was only in place for one of the two quarters and it has only been rolled out for a small portion of Medicaid services. Instead, it's possible that we're seeing "providers reacting to expected changes." Providers know payment reforms are coming and they're preparing for them. In health policy language this is the "sentinel effect" basically, you work more efficiently if you know someone is going to be looking over your shoulder.

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