« Health Innovation Highlights: July 15, 2021 Issue

Full Edition

DIRECTOR’S CORNER

Happy Birthday, Medicare and Medicaid!

Renée Markus Hodin
Deputy Director, Center for Consumer Engagement in Health Innovation

It’s July, which can only mean one thing in health advocacy circles: it’s time to celebrate the birthdays of Medicare and Medicaid! On July 30th, these two pillars of our health care system will turn 56, and we are taking this moment to mark the vital importance of these two programs…and to point to the ways we can make them better and more widely and equitably accessible across our nation.

While we strive to improve the reach and quality of these critical programs each and every day, here are some of the ways we at the Center and Community Catalyst have done so in just the last month! We're:

...working to improve integrated care programs for dually eligible beneficiaries! If you were unable to attend last month’s release of our research findings on making enrollment more person-centered, you can watch the recording.

...promoting better health outcomes for low-income older adults by developing new strategies for integrating health and housing, with a focus on the needs of that demographic group. 

...making recommendations to the Biden-Harris Administration for ways to use Medicaid and Medicare as a means to advance health equity and racial justice.

...pushing for the expansion of Medicaid in states that have, to date, refused to do so.

So, Happy Birthday to Medicare and Medicaid! To paraphrase a saying, “you’re not just getting older, we’re working to make you better!”

Let us know what you’re doing this month to improve Medicare and Medicaid by tweeting us @CCEHI.

FROM THE CENTER & OUR PARTNERS

Center Releases Report on Integrating Health and Housing for Low-Income Adults

 

In partnership with the Leading Age LTSS Center @UMass Boston, the Center this week released a new report, “Policy Options for Integrating Health and Housing for Low-Income Adults”, outlining pathways to improve the integration of health care services with affordable housing for low-income older adults.

In recent years, there has been an increased recognition of the impact of stable and quality housing on health outcomes, including for older adults with complex health and social needs. Moreover, the COVID-19 pandemic, which severely impacted older adults and particularly older adults of color, has forced a rethinking of our long-term care system. As we straddle the pandemic and post-pandemic world, we have a unique window of opportunity to re-envision care for older adults that meets their needs.

The Center embarked on research to understand the barriers to successfully linking affordable housing and health care and chart potential solutions. Through focus groups with low-income older adults and stakeholder interviews, our research surfaced five key building blocks for success:

  1. Emphasizing collaboration;
  2. Ensuring resident control;
  3. Being aware of what matters to residents;
  4. Making it easier to secure capital and finance projects; and
  5. Convening stakeholders to grow connectivity within the field

Video Recording of Duals Person-Centered Integrated Care Enrollment Event Now Available

The video recording of the Center’s June 24 virtual event, First Stop Enrollment: Getting it Right for Medicare-Medicaid Enrollees, is now available.  The event was coordinated with the release of a new report and tool kit sharing strategies to make duals enrollment practices more person-centered.  

The event featured state and federal officials and health plan leaders who joined us to discuss the Center’s research findings and recommendations for improving enrollment into integrated care programs for dually eligible individuals. The panel for the event included Melanie Bella, the first Director of the Medicare-Medicaid Coordination Office (MMCO) at the Centers for Medicare and Medicaid Services (CMS) and Lindsay P. Barnette, a current director at the MMCO. Other speakers included representatives from Inland Empire Health Plan, the Institute for Community Health, Administration for Community Living (ACL) Office of Healthcare Information and Counseling and Ohio Medicaid.

Maine Partner Helps Achieve Legislative Expansion of NEMT Funding in the State

Center partner Maine People's Alliance helped secure enough votes to pass LD17, a bill that provides funding for a pilot program in nonmedical transportation services to older adults and adults with disabilities receiving home and community benefits under the MaineCare Program. This legislative success is a big step toward repairing the state's Medicaid transportation system that crumbled when it was privatized during a previous administration.

The final step is selecting the best funding mechanism, and advocates hope to secure federal funds through the American Rescue Plan Act (ARPA). To read more about this path toward expanding access to Medicaid transportation coverage, check out: Program to Give Rides for Non-Medical Errands to Eligible Seniors and Legislature advances transportation pilot for older Mainers, people with disabilities

RFI Response: Advancing Equity Through Government

 

On July 6, Community Catalyst submitted a response to a Request for Information (RFI) from the Office of Management and Budget on Methods and Leading Practices for Advancing Equity and Support for Underserved Communities through Government. The RFI asked for public input on how federal agencies can best implement President Biden’s Executive Order 13985, which directs the federal government to “pursue a comprehensive approach to advancing equity for all.” Our response included recommendations from all of our programs and focused on policies and practices for addressing known barriers to Medicaid, Medicare and Affordable Care Act coverage, as well as for improving the health of individuals and communities.


Center Staff Contribute to 2021 MACPAC Report to Congress

Each June, The Medicaid and CHIP Payment and Access Commission (MACPAC) releases its "Report to Congress on Medicaid and CHIP." MACPAC's annual reports are an important resource for Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). These reports provide background on these programs, as well as research and analysis, so that policy makers can make better-informed decisions on policies that affect millions of Americans.

This year several Center staff members shared their time, expertise, and insight as MACPAC prepared the June 2021 Report. Deputy Director Renée Markus Hodin, Director of State and Local Technical Assistance Andi Mullin, Senior Policy Analysts Rachelle Brill and Leena Sharma, and Evaluation Manager Madison Tallant provided greater understanding and policy recommendations for two chapters in the report. The first of these is focused on the non-emergency transportation (NEMT) benefit in Medicaid, which includes policy recommendations that specify greater state oversight and that any advisory boards need to have NEMT users on it. The second topic involves state strategies for integrating care for people who are dually eligible for Medicaid and Medicare. This section includes strategies for state contracts with dual eligible special needs plans and for states with Medicaid managed care, with particular attention toward using existing contracting authority to better integrate care through Medicare Advantage dual eligible special needs plans (D-SNPs). The full report is available here.

WISH Act Introduced, Seeks to Help Older Adults Stay in Their Homes

For decades, stakeholders in the Long-Term Services and Supports (LTSS) system have identified the need for affordable insurance for long-term and catastrophic care. As it stands now, most retirees will have no way to pay for needed services during disability in old age, and without legislative action, millions of older adults will become destitute, homeless, and find their only recourse, placement in a Medicaid-funded nursing home, causing Medicaid costs to skyrocket.

Earlier this month, the Well Being Insurance for Seniors to be at Home (WISH) Act, sponsored by Rep. Thomas R. Suozzi (D-NY-3), was introduced in the House. This legislation would create a public-private partnership to provide federal catastrophic long-term care insurance. Center Research Director Marc Cohen, an expert in long-term care insurance, contributed to the drafting of the legislation. The WISH Act will supplement social security for those with the greatest need, so that Americans can choose to age in their homes, families will have financial protection, elders will not become impoverished, workers will not be forced to leave their jobs to care for their family members, and Medicaid costs will be reduced by a quarter. For more information, read the fact sheet one-pager, the presentation by Rep. Suozzi, the full bill text and a section-by-section summary of the WISH Act.

Principles: Improving Community Economic Stability Through Hospital Billing Policies

Community Catalyst’s Community Benefit and Economic Stability Project released a set of principles to guide consumer advocacy efforts in campaigns to ensure that hospital policies promote economic security and preserve access to care for all. These principles – equity, transparency, affordability, inclusivity and accountability – are particularly important since financial security is an important social determinant of health yet, too often, the health care system itself is frequently a contributor to financial hardship among families. Moreover, hospitals are important anchors in their communities and an integral part of the health care safety net. Despite this standing, their financial assistance and billing/collection policies frequently exacerbate existing inequities. Data show that Black and brown people and other oppressed or excluded populations are the most affected by unaffordable health care and medical debt.

Center Research Director Featured in Podcast on Long-Term Care Financing

 
Podcast host Melissa Batchelor and guest Marc Cohen discuss long-term care and future trends for the industry.

On a recent episode of the podcast "This Is Getting Old: Moving Towards an Age-Friendly World," host Melissa Batchelor from George Washington University invited the Center's Research Director, Marc Cohen, to discuss the basics of how long-term care is paid for now, and discuss future trends for the long-term care insurance industry. This episode, "Do I Need Long-Term Care Insurance? And Future Trends," is available for streaming or download here.

NOTEWORTHY NEWS & RESOURCES

With Workers in Short Supply, Desperate Older Adults Often Wait Months for Home Care

Many older adults in need of home care are facing long delays in receiving services due to the workforce shortage at nonprofit aging services providers. An article in Kaiser Health News reports the story of one homebound older adult who has had to wait months to receive care from a personal aide. Lack of funding has played a role in this shortage as state and federal reimbursement rates to elder care agencies are inadequate to cover the cost of quality care and services or to pay a living wage to caregivers. With the potential for increases in federal funding, the article emphasizes that the money must be targeted for recruiting, training and retaining workers, as well as providing benefits and opportunities for career growth.

New Research: Some Hospitals Kept Suing Patients Over Medical Debt Through the Pandemic

ProPublica reported at least 16 nonprofit hospital institutions that pursued lawsuits, wage garnishments and liens against patients during the first seven months of 2020. John Hopkins University and Axios released a report looking into debt collection court records by U.S. hospital and health systems from 2018 to 2020; it was reported that more than a quarter of the nation's largest institutions pursued nearly 39,000 legal actions seeking more than $72 million. Of the 16 institutions taking legal action, Froedert Health, a Wisconsin health system, sought the most money from patients - more than $3 million.

A Stronger, Bolder, More Equitable HCBS System

Justice in Aging published an article in Generations Today explaining why older adults, especially older adults of color, have few options for receiving affordable care within their homes and outlining opportunities to address racial inequities in access to high-quality home and community-based services (HCBS). Medicaid has historically only included coverage for care provided in institutions like nursing facilities and despite some progress, Medicaid HCBS is still not an entitlement. The article goes on to describe how the proposed HCBS Access Act of 2021 would remove this major barrier by requiring states to cover HCBS, thus providing people with disabilities and aging adults with a meaningful choice at the outset to receive care in their community.

Health Care Models That Pay For Equity

Value-based payment models have become increasingly popular in the movement away from fee-for-service payment models. But current value-based payment models have a blind spot when it comes to equity, according to a blog post by the Lown Institute. The post outlines takeaways from a recent JAMA Viewpoint on how value-based payment models can prioritize and advance health equity. Proposed strategies include CMS setting national long-term “pay-for-equity” goals, including equity as part of the definition of high-value care, and creating an equity agenda to guide policymakers toward achieving equity goals.

A New Opportunity for States to Support Dual-Eligible Populations

Better integration between Medicare and Medicaid could improve care for millions of people in the U.S. eligible for both programs, yet only about 10 percent of this population is served by integrated care programs. Advancing Medicare & Medicaid Integration is a new funding opportunity designed to help states meaningfully improve Medicare-Medicaid integration for dual-eligible individuals. Led by the Center for Health Care Strategies, with support from Arnold Ventures, the initiative will support state efforts to design integration models, expand access to existing integrated programs, or improve integrated care and services, with a focus on health equity.

2021 Lown Institute Hospital Index Ranks Hospitals on Community Benefit Spending

The Lown Institute just released its top hospitals for community benefit for over 3,600 U.S. hospitals. The hospitals were ranked based on charity care spending, spending on other community health initiatives, and the proportion of patient revenue from Medicaid (a measure of the hospital’s commitment to taking care of low-income patients). The Institute also calculated “fair share spending” for 2,391 private nonprofit hospitals by comparing each hospital’s spending to the value of its tax exemption.

Home-Based Primary Care: Reinventing the House Call for Adults with Complex Needs

High-quality home-based primary care can serve as a critical tool to provide more person-centered care to underserved populations, reduce health care disparities, and curb spiraling costs associated with unnecessary hospital visits or nursing home admissions. The Better Care Playbook has just released a new set of resources to advance this work. Health care stakeholders can use this Playbook Collection – a curated set of research and resources – to understand the latest evidence behind home-based primary care models and explore practical tools and case studies to guide implementation of home-based primary care.  

With an estimated two million homebound adults in the U.S. today and the nation’s older adult population increasing, home-based primary care is putting a new face on the “house calls” of yesteryear. As the shift to home- and community-based care continues, health care organizations are seeking new options for providing health care services in the comfort of the home. Home-based primary care is particularly valuable for frail older adults and people with disabilities who have multiple chronic conditions, functional impairments, and/or social challenges that make office or hospital visits difficult.

STATE HIGHLIGHTS

Colorado

The Centers for Medicare and Medicaid Services published the final evaluation report and the concluding Demonstration Year 2 and Demonstration Year 3 Medicare Cost Savings Report for the Colorado managed fee-for-service model demonstration under the Medicare-Medicaid Financial Alignment Initiative. The Colorado demonstration ended December 2017. A few key highlights from the reports include:

  • RCCOs had limited prior experience with formal care coordination for individuals with complex needs. As a result, for a number of reasons, they faced challenges managing large numbers of new enrollees each month, including challenges meeting demonstration requirements to complete service coordination plans (SCPs) for all enrollees.
  • Passive enrollment into the program may have been a contributing reason many participants in 2016 and 2017 focus groups were unaware of any demonstration-related changes in their health care delivery or care coordination. Beneficiary advocates suggested that one explanation for this may have been that a large portion of the enrollee population never heard from their care coordinators.
  • There are varying levels of changes in services utilization; in particular, demonstration effect for the LTSS population was different than the effect for the non-LTSS population, with LTSS users experiencing increases in the probability of inpatient admissions, ambulatory care sensitive condition (ACSC) admissions (overall and chronic) and skilled nursing facility.
  • The cost savings analyses indicates that the demonstration was not associated with statistically significant savings or additional costs to the Medicare program. Separate actuarial analyses conducted for performance payment purposes did not find any gross Medicare Parts A and B savings resulting from the demonstration and CMS did not make any performance payments to the State.

Minnesota 

The Centers for Medicare and Medicaid Services published the third evaluation report for the Minnesota demonstration, which focused on aligning administrative functions to improve dually eligible beneficiary experience. A few key highlights from the report include:

  • The Demonstration Management Team (DMT), which includes State and CMS staff, serves as one the most important components of the demonstration and has become more effective over time given its consistent membership. The DMT helped address changes at the Federal and State levels, such as changes in the Special Enrollment Period (SEP) for Medicare-Medicaid beneficiaries, the introduction of D-SNP look-alike plans, and changes in the Medicare guidelines for beneficiary materials.
  • Implementation of a single integrated Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey continues to reduce the burden for plans and beneficiaries.
  • The State took steps to implement consultant recommendations to improve the value-based purchasing program for plans serving older adults and individuals with disabilities.

Nevada

Nevada Gov. Sisolak signed S.B. 248 into law requiring collection agencies to notify consumers no less than 60 days before taking any collective action on medical debt. Collection agencies will also be prohibited from initiating civil action if the amount of the medical debt is less than $10,000. Collectors will be prohibited from charging fees of more than 5 percent of the total medical debt, excluding interest, late fees, collection costs, attorney fees, and other costs.

New York

The Centers for Medicare and Medicaid Services published a combined second and third evaluation report for the New York Fully Integrated Duals Advantage (FIDA) capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative. The demonstration ended in December 2019. A few key highlights from the report include:

  • Enrollment in the demonstration was low from the start and continued to decline from 2017 through 2019
  • During 2017 through 2019, most primary care providers did not participate in the Interdisciplinary Team (IDT) as envisioned. A plan that paid providers for their time had more success in engaging them in the IDT.
  • Most 2017 focus group participants expressed overall satisfaction with FIDA. They felt that FIDA had improved their access to needed medical and specialty services, as well as their quality of health, life, and independence. Most also said their care management was effective.
  • The FIDA demonstration successfully streamlined the appeals process for enrollees through integrating appeals at the plan level and automatically forwarding adverse plan decisions to a State office (IAHO) that determined the outcome by applying both Federal Medicare and State Medicaid policy

Oregon

McKnight’s Senior Living reported earlier this month, that the Oregon legislature passed a series of bills focused on supporting long-term care providers. The bills include an optional “wage add-on” program for Medicaid providers that meet certain criteria, codified practices to ensure assisted living and other community-based care providers use acuity-based staffing plans, $30 million to create the Oregon Essential Workforce Health Care Program, and a study on the cost of long term care and the adequacy of Medicaid reimbursement.

Virginia

 The Centers for Medicare and Medicaid Services published the evaluation report for the state’s Commonwealth Coordinated Care (CCC) capitated model demonstration under the Medicare-Medicare Financial Alignment Initiative. The Virginia demonstration ended December 2017. A few key highlights from the report include:

  • Many stakeholders deemed care management, the core function of CCC, as successful, and stated that it had often made notable differences in individual enrollees’ health and well-being. However, care managers described challenges meeting the demonstration’s requirements for care management, e.g., required timeframes and processes for reaching enrollees, and engaging enrollees and providers in assessments, plans of care, and interdisciplinary care teams
  • Focus group participants’ familiarity with care managers improved over the course of the demonstration, and most participants reported being connected to the health care system, either through their primary care physician, specialist, or home health aide.
  • The results of Medicare cost analyses using a difference-in-differences regression approach indicate increased costs in the demonstration group relative to the comparison group for all three demonstration years. This is based on Medicare Parts A and B expenditures and does not include Medicare Part D or Medicaid data.

Washington

 The Centers for Medicare and Medicaid Services (CMS) published the fourth evaluation report, and the demonstration Year 4 final and demonstration Year 5 preliminary Medicare cost savings report for the Washington managed fee-for-service model demonstration under the Medicare-Medicaid Financial Alignment Initiative. A few key highlights from the reports include:

  • Through interviews with  State officials in 2019, they reported an engagement rate—the percentage of enrollees receiving active assistance from a health home—of 44 percent, which is comparable to other similar heath home programs nationwide.
  • Cost savings analyses indicates significant gross Medicare Parts A & B savings. The savings are estimated at over 8 percent during the first 3 demonstration years 2 and the savings increased to over 11 percent over demonstration years 4 and 5.
  • Over the course of the demonstration, there have been decreases in skilled nursing facility (SNF) admissions, long-stay nursing facility use, and physician visits for the overall demonstration eligible population.

KEY DATES

 Wednesday, July 21 (12-1 p.m. Eastern) - Webinar: Public Sector Briefing: Person Driven Outcomes, presented by NCQA. Please register for the webinar.  

Wednesday, July 21 (1-2 p.m. Eastern) - Webinar: A New Opportunity for States to Support Dual-Eligible Populations, presented by Advancing Medicare & Medicaid Integration. Please register for the webinar.  

Wednesday, July 21 (3-4 p.m. Eastern) - Webinar: Vaccine Equity Bright Spot Briefing: Standout Communities in the Southern U.S., presented by the Vaccine Equity Cooperative. Please register for the webinar.

Wednesday, July 21 (4-5 p.m. Eastern) - Webinar: Harm Reduction Strategies to Save Lives, presented by the American Medical Association (AMA) and Manatt Health). Please register for the webinar.  

Friday, July 23 (1:30-2:30 p.m. Eastern) - Webinar: Caregiving in a Pandemic: What's Next for Diverse Caregivers, presented by the National Alliance for Caregiving and The John A Hartford Foundation. Please register for the webinar.  

Thursday, August 5 (2-3 p.m. Eastern) - Webinar: Social Isolation and Loneliness Among Adults with Serious Mental Illness, presented by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). Please register for the webinar.