Health Innovation Highlights: February 13, 2019

Full Edition

FROM THE CENTER & OUR PARTNERS

Center’s New Educational Video Series Shares Best Practices for Improving Primary Care for People with Involved Disabilities

Last week the Center released a new video series that explores the ways the traditional medical system fails people with involved disabilities, and how the values of the Independent Living model and home-based primary care can create real, meaningful improvements in quality of life. The series is offered in four parts (each 11-13 minutes in duration) and features Dr. Robert Master and other clinician and consumer leaders with expertise in these areas.

A Flurry of New Center Publications to Start the Year

The Center has released a number of publications over the past month including reports on the Financial Alignment Initiative and the future of integrated care, an updated LTSS Advocacy toolkit, an update of the Center’s 2017 “Medicaid ACO Checklist for Advocates” toolkit, and a brief that recaps five years of the Eldercare Voices guest columns featured periodically in this newsletter:

  • Five years ago, as part of the CMS Medicare-Medicaid Financial Alignment Initiative, participating Medicare-Medicaid Plans in 10 states were required to create Consumer Advisory Councils to provide feedback on enrollees’ care experience. See the Center’s report on their effectiveness and companion document with key findings.
  • States are expanding the use of managed long-term services and supports (MLTSS) for individuals with intellectual and developmental disabilities (I/DD), which can provide benefits for consumers, but also come with potentially serious risks for people with I/DD. To provide guidance to advocates and policymakers in states that are transitioning to MLTSS for people with I/DD, we have updated our online toolkit Strengthening Long-Term Services and Supports: A Tool to Assess and Improve Medicaid Managed Care. Given the unique needs of this population, we focused primarily on updates to the Stakeholder Engagement and Person-Centered Processes sections, but other updates relevant to people with I/DD and other populations using LTSS can be found throughout the tool.
  • The Center has updated its “Medicaid ACO Checklist for Advocates” toolkit, originally released in 2017. This contains a list of items advocates should consider as Medicaid ACOs are designed and implemented. The new update includes new examples from states with experience in particular aspects of implementation such as: Orgeon’s holding of its coordinated care organizations accountable for care transition quality and patient readiness for transitions; and Vermont’s requirement that ACOs maintain a hotline for complaints and grievances. The update also includes an expanded section on incorporating the social determinants of health into Medicaid ACOs.
  • Eldercare Voices Columns: Perspectives from Leading Geriatrics Health Professionals” is a Center brief that looks back at five years of guest columns written by leading geriatrics and gerontological professionals, highlighting topics within the geriatrics field that have particular relevance for older adults, their caregivers and the care they receive. The brief reprints two of the most popular columns in each three broad areas: Models of Care; Geriatrics Clinical Topics; and Advocating for Better Care. The Appendix lists all the columns by author and title, with links to each.

Advocates in West Virginia Take on Systems Change Amid Epidemic

In January, Kelli Caseman, director of Child Health at West Virginians for Affordable Health Care  (WVAHC), a Center partner, wrote an op-ed calling for a state plan for addressing the opioid crisis in a collaborative way. WVAHC is working with stakeholders across the state to assess and address gaps in health services available for children in schools.  As the state is ravaged by the opioid epidemic and unprecedented numbers of children being uprooted from their homes, placed in foster care, and dealing with untreated trauma, WVAHC is bringing together policy makers, school administrators and nurses, pediatricians, parents, social workers and other community members to design a model policy to ensure continuous health care coverage for students and stable medical homes for their treatment.

Center Director Joins “POLITICO Live” Discussion on Health Innovation

Last month, Center Director Ann Hwang joined POLITICO’s Health Care Innovators’ panel of experts in Washington, D.C., to discuss the many ways technology has changed, disrupted and transformed the health care landscape. Video of the full panel discussion is now available on POLITICO’s website.

Center Offers Comments on Quality Measures

The Center submitted comments to Mathematica Policy Research – which is working with CMS to design new long-term services and supports (LTSS) measures – regarding the proposed quality measure for new Medicaid LTSS beneficiaries. The Center urged the adoption of a broader approach to quality measurement that will better assess quality of care by focusing on beneficiaries’ experience and quality of life, and most fundamentally, whether their needs for long-term services and supports are being met.

NOTEWORTHY NEWS & RESOURCES

Commonwealth Fund Resource Helps Health System Players Better Understand Experience of High-Need, High-Cost Patients and Their Caregivers

To improve the experiences of those who rely on our health system the most, The Commonwealth Fund partnered with Healthwise, a health care nonprofit, to focus on patients' needs in their own voices as a way of identifying gaps in care. As part of this research, "personas" were created which help depict the experiences, motivations and goals of a group of patients. This information can help health system leaders, payers and policymakers address flaws in care and processes.

Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies

A study originally published in the Journal of General Internal Medicine and made available on the Better Care Playbook website, identifies common barriers to engaging high-need patients including: physical symptoms/limitations, mental illness, care fragmentation, lack of social support and financial insecurity. The study also identifies strategies and program features that enhance patient engagement and support communication.

MMCO Releases Informational Bulletin to Support Dually Eligible Individuals' Access to a Range of Medical Equipment

A new Bulletin from CMS’ Medicare-Medicaid Coordination Office (MMCO) provides an additional strategy to help increase dually eligible individuals’ access to durable medical equipment, prosthetics, orthotics and supplies. This new strategy encourages states to create "Medicare Non-Covered Items" lists and use them to immediately process claims for an item they know that Medicare will not cover. This would eliminate the need to require proof of Medicare denial and minimize burden on states. This strategy adds to those contained in a January 2017 MMCO bulletin.

A new Bulletin from CMS’ Medicare-Medicaid Coordination Office (MMCO) provides an additional strategy to those in the January 2017 bulletin to help increase dually eligible individuals’ access to durable medical equipment, prosthetics, orthotics and supplies.

New Study Highlights Importance of Employers Supporting Caregivers

A study from the Harvard Business School examines how people providing care to family members or friends are faring professionally, how these responsibilities are affecting them at work, and the shortcomings and future implications of employers failing to support the country’s growing cadre of caregivers. Based on a nationally representative survey, the report shows the urgency of this issue and provides common-sense solutions for how employers can support their employees who are providing important care to family and friends.

STATE HIGHLIGHTS 

Alabama

Last month, the state’s Medicaid agency released a request for proposals (RFP) for the Alabama Coordinated Health Network (AHCN), which aims to consolidate care coordination services across various state Medicaid programs. Under the ACHN, the state will contract with Primary Care Case Management Entities in seven newly-defined regions to coordinate services. The new contracts will be in effect Oct. 1, 2019, through Sept. 30, 2021.

Connecticut

The Connecticut Department of Social Services is facing a class action lawsuit for failing to provide Medicaid recipients adequate transportation for medical appointments. The CT Mirror reports that the Connecticut Legal Services filed the lawsuit on behalf of six Medicaid beneficiaries.

Massachusetts

The commonwealth of Massachusetts will administer a patient experience survey to enrollees in the 17 Medicaid Accountable Care Organizations in the state. The survey will focus on quality of primary care, behavioral health care and long-term services and supports. Results of the survey will be publically available in 2020. The results will hopefully shed light on how well Medicaid providers have done at providing care for patients since the restructuring of the Medicaid program. The information will also be used to allow the state to direct higher payments to better performers.

New York

The New York State Department of Health assembled a stakeholder group to start the planning process for how the state will provide integrated care for its dually eligible population once the state’s dual eligible demonstration project, the Fully Integrated Duals Advantage (FIDA) program, sunsets in December 2019. As reported by Health Management Associates, the stakeholder meeting reviewed the experience of the FIDA program, as well as the other managed care programs serving the dual eligible population. It also reviewed a recently released proposal from the Centers for Medicare and Medicaid Services identifying 10 opportunities for improving integration between Medicare and Medicaid services for dual eligibles, as well as experiences with duals integration in other states that potentially may provide models for New York.

North Carolina

A recent Health Affairs blog summarizes the rapid and innovative health care transformations that the state of North Carolina is undergoing. Medicaid, Medicare, the commercial market and employer market are all set to undergo major transformations in how care is being paid for in the state.   And it is the first state in the country that has a CMS approved Medicaid waiver that will link payment reforms explicitly to address the social determinants of health. Through Healthy Opportunities Pilots, funded with $650 million of state and federal money over five years, Medicaid managed care plans are expected to cover evidence-based interventions targeting four key areas: housing stability, food security, transportation access, and interpersonal safety. In the commercial market, Blue Cross Blue Shield of North Carolina (BCBS NC) will contract with five health systems to participate in the Blue Premier program, representing a quarter of the insurer’s total payments. The five-year contracts will  implement ACO payment models starting in 2020.  The state will also be focused on revamping some the Medicare transformation initiatives the state participating in (e.g. ACOs, Comprehensive Care for Joint Replacement (CJR) and Bundled Payments for Care Improvement Advanced (BPCI-A)). Finally, in the employer market, the state’s chamber of commerce has developed a “Roadmap to Value-Driven Health.” Authors of the blog caution that to make these transformations work providers and organizations that work with them will need to make investments into the success of the programs; as well as public and private stakeholders will need to continue to engage North Carolinians for these reforms to succeed.

Oregon

In late January, the Oregon Health Authority released its Coordinated Care Organizations (CCO) 2.0 request for applications (RFA). The state has received 24 letters of intent under this RFA. Under CCO 2.0, the CCOs will provide full-risk coordinated care with a focus on prevention, improving quality, accountability, eliminating health disparities and lowering costs. CCOs will also be required to address Social Determinants of Health and Health Equity (SDOH-HE) by directing a portion of spending on SDOH-HE and ensuring their work with community partners addresses community priorities.

Washington

The Integrated Care Resource Center (ICRC) published a new report on the Financial Alignment Initiative (FAI) in Washington state. The first state to launch an FAI demonstration, Washington pursued the managed fee-for-service financing model. The ICRC case study describes: (1) the demonstration’s structure; (2) results achieved to date; and (3) insights on the demonstration’s implementation from the state and other stakeholders.

KEY DATES

Friday, Feb. 15 (2-3:30 p.m. Eastern) Webinar: Promising Practices in Managed Long-Term Services and Supports: Network Adequacy and Accessibility, presented by the Community Living Policy Center within the Lurie Institute for Disability Policy at Brandeis University with support from the Administration for Community Living. Please register for the webinar.

Wednesday, Feb. 20 (1-2 p.m. Eastern) – Webinar: Building Age-Friendly Health Systems, One Community at a Time, presented by the Aging and Disability Business Institute. Please register for the webinar. 

Wednesday, Feb. 20 (2-3 p.m. Eastern) – Webinar: Time for Better Upstream Strategic Thinking: Lessons from the Field, presented by HealthBegins, Blue Shield of California Foundation and USC Gehr Family Center for Health Systems Science. Please register for the webinar.

Tuesday, March 5 (12:30-2 p.m. Eastern) – Webinar: Recruiting Members and Supporting Participation in Plan Governance, presented by The Lewin Group, in collaboration with the Center for Consumer Engagement in Health Innovation. Please register for the webinar.