This week our In Focus section reviews scenarios in which the federal Public Health Emergency (PHE) may expire. In the weeks ahead, the U.S. Secretary of Health and Human Services (HHS), Xavier Becerra, will be faced with the decision of whether to extend the PHE or to allow it to expire. Dozens of critical waivers and coverage flexibilities are currently linked to the federal PHE and have enabled patients, providers, and payors to receive, deliver, and pay for health care for nearly two years. To date, the PHE has been extended eight times, each for the maximum allowed 90 days. However, declining COVID-19 infection rates and actions by state governors to relax COVID-19-related public health measures have renewed pressure on the Biden Administration to signal how they will choose to act on April 16, 2022 when the current federal PHE expires.
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Issue brief examines greater flexibility for primary care models
An issue brief released today outlines new Medicare payment models that offer greater flexibility and aim to shift more care to primary care models, moves that can improve quality and reduce costs. 量子资源网 authors, Jennifer Podulka, Yamini Narayan, and Lynea Holmes found the two newest primary care payment models, Global and Professional Direct Contracting (which will be re-branded as Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) beginning January 1, 2023) and Primary Care First offer more flexibility than previously released approaches and represent a promising step forward for primary care.
The report, , also notes that to increase the likelihood that models achieve overall cost savings and/or quality improvement, one option for the Center for Medicare and Medicaid Innovation is to test approaches that place greater value on primary care and give primary care providers greater flexibility to tailor care for people outside of a fee-for-service system. These changes could improve people鈥檚 access to care, the quality of care received, and quality of life.
量子资源网, Milbank brief examines nursing facility care
Residents in nursing facilities faced higher infection rates and worse overall care experiences during the COVID-19 public health emergency highlighting long-standing concerns about the quality and cost-effectiveness of nursing facility care, especially for residents of color.
In a recent issue brief published by the Milbank Memorial Fund that 量子资源网 COO Chuck Milligan co-authored with Kate McEvoy, a program officer with Milbank, examined disparities in access, levels of care, and resident outcomes, and provided recommendations and guidance for the Centers for Medicare and Medicaid Services (CMS) on future approach to federal policy in nursing facilities.
The brief, , suggests CMS take the following steps to improve nursing facility oversight and care:
- Endorse linkage of any further public health emergency-related funding or other federal financial reimbursement to quality improvement.
- Align Medicare and Medicaid efforts to promote payment policies that are based on risk adjustment for complex care and incorporate value-based payment principles, eliminate unintended consequences of federal policies such as routine approval of nursing home bed taxes, and adopt a common foundation of quality measures.
- Expand existing guidance on rebalancing long-term services and supports.
- Enhance conditions of participation for nursing homes and hospitals by including structural measures such as census and staff turnover.
- Build out existing mechanisms like Care Compare to enhance public transparency, availability, and usability of cost report and ownership information and to provide timely and complete information on nursing facility citations.
Issue brief proposes local option for uninsured
Examining the more than 3 million non-elderly poor adults in states without Medicaid expansion, the 量子资源网 team of Matt Powers and former 量子资源网 colleagues Nora Leibowitz and Jack Meyer, have authored an issue brief proposing a local health insurance option to fill gaps for these individuals who frequently lack access to meaningful healthcare.
The brief, , published by the , recognizes the critical role local entities and providers play in providing care and proposes a Local Choice Option, could:
- Provide a comprehensive insurance product that promotes appropriate access to healthcare and better health outcomes
- Repurpose funding now used only for direct care to provide healthcare more efficiently
- Support local customization and create an alternative to an open-ended entitlement program in states where that is not currently politically tenable
The brief concludes a Local Choice Option would be a sound investment with the potential for quick implementation and benefits of health insurance not currently available to people living in poverty in non-expansion states.
CMS to accept applications for new Medicare ACO REACH model
This week our In Focus section reviews the Centers for Medicare & Medicaid Services鈥� (CMS) Innovation Center鈥檚 newly announced model 鈥� Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH). CMS will accept applications from organizations interested in participating and is particularly interested in partnering with provider-led organizations and similar groups with direct patient care experience and a strong track record serving underserved populations that focus on primary care to better manage Medicare beneficiaries鈥� health. Applications are due by April 22, 2022.
Iowa releases Health Link Medicaid managed care RFP
This week, our In Focus section reviews the Iowa Health Link request for proposals (RFP) for Medicaid managed care organizations (MCOs) to serve the state鈥檚 traditional Medicaid program, the Children鈥檚 Health Insurance Program (CHIP) known as Healthy and Well Kids in Iowa (Hawki), and the Iowa Health and Wellness Plan (IHAWP). The RFP was released by the Iowa Department of Human Services on February 17, 2022. Contracts are set to begin July 1, 2023, and are worth approximately $6.5 billion annually.
Report examines the value of community behavioral health providers and their networks
A recent report examines the importance of behavioral healthcare (BH) and its ability to improve outcomes and reduce costs when integrated in meaningful ways with medical services, especially primary care.
An 量子资源网 team of behavioral health experts, including Annalisa Baker, Ann Filiault and Josh Rubin, published the report, with the New York State Council for Community Behavioral Healthcare and the New York State Collaborative BH Independent Provider Associations (IPA).
Patients with mental health and substance use disorders are heavy utilizers of healthcare services and Medicaid spending is nearly four times the cost compared to other enrollees. By developing and working within IPAs, providers can enable community healthcare and come together to establish systems of population care, build technology infrastructures, develop needed workforce and work toward value-based healthcare.
New York state is investing in the development of behavioral IPAs through the Behavioral Health Value Based Payment Readiness Program. The report outlines policy recommendations for promoting BH IPAs and maximize their positive impacts including:
- Facilitate access to data for BH IPAs by enabling them to access the Medicaid Data.
- Warehouse and including data sharing requirements in future managed care contracts.
- Include BH IPAs in network adequacy definitions for Medicaid MCO Contracts to ensure that Medicaid beneficiaries have access to integrated behavioral health care and revise the definition of valid VBP Level 2 or 3 arrangements to include BH IPAs.
- Fund a Phase 2 Infrastructure Program to provide the BH IPAs additional time to realize the goals of the BH VBP Readiness Program.
California releases Medi-Cal managed care RFP for three plan models in 21 counties
This week, our In Focus section reviews the California Medicaid (Medi-Cal) managed care request for proposals (RFP) released by the California Department of Health Care Services (DHCS) on February 9, 2022. DHCS is procuring contracts for commercial plans for three of the Medi-Cal managed care plan models in 21 counties, serving approximately 3 million beneficiaries. Contracts will be awarded to one managed care organization (MCO) in each of the Two-Plan model counties, two MCOs in each of the geographic managed care (GMC) model counties, and two MCOs in each of the Regional model counties. This procurement is the largest released by California, rebidding contracts for commercial plans statewide.