« Health Innovation Highlights: June 27, 2018 Issue

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Center Releases Toolkit on Grassroots Organizing and Delivery Reform

We are excited to release “Where the Magic Happens:  A Guide to Grassroots Organizing for Consumer-Driven Delivery Reform.” This guide synthesizes the successful work the Center has done with state advocates across the country in raising consumer voices in health system reform initiatives and demonstrates that – with adequate resources – building successful and meaningful consumer engagement is both possible and necessary. Featured examples show how our state-based partners are building power among populations who are often the subject of health system reform, but rarely involved at the policy making level – people with disabilities, older adults, low-income communities and more. They also illustrate ways in which these partners can be critical allies for providers and others trying to bring a meaningful consumer voice into delivery reform initiatives.

Please join us July 12, 2017 at 2:00 EDT for a webinar to hear more about the guide and this important grassroots organizing work. You can register for the webinar here.

Tennessee Partners Organizing Consumers

Center partners in Tennessee have begun organizing consumers around enhancing consumer input into the state’s Employment and Community First (ECF) CHOICES program, which provides services for individuals with intellectual and developmental disabilities (I/DD) through Medicaid managed care plans. Family Voices of Tennessee (Family Voices), part of the Tennessee Disability Coalition, is seeking to make sure that the voices of individuals with intellectual/developmental disabilities, their families and conservators are a robust part of the ECF CHOICES project. Family Voices organizers began facilitating listening sessions in all parts of Tennessee in June. The organization will also provide training and support for individuals serving on Advisory Councils created by the state and the managed care plans providing services.

Center Weighs in on Proposed CMS Changes to Dual-Eligible Programs

Center Senior Policy Analyst Leena Sharma was quoted in a Modern Healthcare article on policy proposals submitted to Congress to alter programs for dually eligible individuals, with a stated goal of better coordinating care and reducing costs. Proposals focus on the Part D drug benefit, messaging and marketing materials, appeals processes and special enrollments. In the article, Leena notes the importance of ensuring that these changes are consumer-friendly and communicated in language accessible to Medicare/Medicaid beneficiaries.

New York Advocates Focus on Connection between Transportation and Health

As residents of North Brooklyn, New York face the impending 15-month shutdown of the L Train starting in April 2019, Center partner Make the Road New York is weighing in on the importance of an adequate and healthy transportation mitigation plan. At a rally in early June attended by many MRNY members, residents focused on the need for adequate bus transportation all day, not just during rush hour, including bus transportation that does not add needlessly to air pollution in the neighborhood. MRNY is working with environmental justice organizations on a campaign to insure that the shutdown does not worsen the health of Brooklyn residents.

TakeAction Minnesota Announces New Executive Director

Long-time Community Catalyst and Center partner TakeAction Minnesota (TAMN) has announced that it has hired a new Executive Director. Elianne Farhat, TAMN’s current Program Director, will take the reins from outgoing ED Dan McGrath, who is leaving after 12 years at the helm of TAMN. In addition to her work at TAMN, Elainne has significant state and national experience, including stints at the Center for Popular Democracy, the PICO National Network, and the Minnesota AFL-CIO. She begins her new role on September 4, 2018. In August, TakeAction will be celebrating Dan’s incredible contributions to the organization, the state of Minnesota, and health advocacy nationally. The Center joins TAMN both in honoring Dan’s tremendous contributions, and in welcoming Elainne to her new role! 


MMCO Delivers Annual Report to Congress

The Medicare-Medicaid Coordination Office (MMCO) submitted its annual report to Congress earlier this month detailing the activities it undertook in FY17 to better serve Medicare-Medicaid beneficiaries. With the goal of improving beneficiary access and ensuring the quality of health services, CMS reported working on a number of initiatives in FY17 to prevent billing errors, incentivize integrated care and financing, reduce avoidable hospitalizations, approve demonstrations that move away from fee-for-service models, strengthen ombudsman support services and provide one-on-one counseling and education services for beneficiaries about their health care options.

This work is particularly important because Medicare-Medicaid beneficiaries have a higher prevalence of many high-risk, high-cost conditions – including diabetes, heart disease and mental illness – than Medicare-only or Medicaid-only enrollees, and account for a much higher percentage of costs. The report describes how the “lack of alignment and cohesiveness between programs” may result in fragmented care for dual eligibles and perverse incentives for both health providers and payers. Noting that everyone – Medicare-Medicaid beneficiaries, payers, providers, health systems, etc. – benefits when systems are aligned and quality is measured and improved, the report makes the following recommendations for future legislative action:

  • Permanently extend the current Medicare Part D demonstration that allows CMS to more accurately reimburse for services utilized, instead of relying on the standard prospective payment system, to improve payment value;
  • Create a coordinated CMS-state review process for marketing materials targeting “Dual Eligible Special Needs Plan (D-DNP) enrollees to reduce administrative costs and burdens;
  • Improve care coordination and limit confusion and administrative burden on both payers and beneficiaries by streamlining appeals communication requirements on health plans that integrate Medicare-Medicaid payments; and
  • Narrow the Part D Special Enrollment Period utilization and marketing to include only full Medicare-Medicaid beneficiaries to more efficiently offer options to high-risk, high-need beneficiaries and reduce administrative burdens.

Recap of New Medicare Advantage Plan Flexibility: What’s Good and What’s Next?

A post in The Commonwealth Fund’s To the Point blog deconstructs recent CMS policy changes aimed at giving Medicare Advantage plans more flexibility and offers recommendations about future accountability. This bite- sized recap describes the history of Medicare Advantage plans, and the ways that widening the array of services available through these plans helps meet consumer needs. Previously, supplemental benefits available under Medicare Advantage plans included items like dental and vision services, but beginning in 2019, the list of available benefits will expand to include coverage for non-skilled homecare workers, portable access and assistive devices, food, transportation and chronic supplemental benefits. This flexibility also will likely lead to an increase in demand for palliative care programs, provided that these programs can increase their capacity to fill service gaps and partner with payers. While this flexibility will certainly provide consumers better access to the care and services they need, blog authors Wynne and Horowitz caution that flexible services – and more revenue – will require greater CMS scrutiny regarding the overall value of this care. The authors suggest implementing quality measures gauging improvement in outcomes and equity in access.

MACPAC Delivers June Report; Focuses on Rx Drug Costs, Opioid Epidemic and MLTSS

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June report to Congress on Medicaid and CHIP. The report makes recommendations intended to close rebate loopholes, improve access to coordinated care, and identify areas for future research.

  • Chapter 1 focuses on the Medicaid Drug Rebate Program and mechanisms for reducing spending by closing manufacturer loopholes like those that allow manufacturers to sell drugs to a subsidiary or misclassify a brand drug as a generic to reduce their rebate obligation;
  • Chapter 2 recommends streamlining substance use disorder (SUD) confidentiality regulations and providing guidance and technical assistance to reduce confusion for patients, providers, and payers;
  • Chapter 3 describes the deficiencies in current quality measures used to assess managed long-term services and supports (MLTSS) and the resulting lack of comparable outcomes between states, and further suggests that MACPAC will work to identify the key components states are using to create integrated care models so that they can be evaluated against one another; and
  • Chapter 4 describes the layers of systemic obstacles that prevent patients from seeking or accessing care including the fact that only 12 states currently pay for all services related to SUD treatment, and very few patients have access to integrated care.

WWGD: What Will Gawande Do?

The widely-reported Amazon/JP Morgan/Berkshire Hathaway health care organization, announced in January and still in the planning stages, will hit the ground running with the recent naming of Dr. Atul Gawande as its new CEO. Dr. Gawande, a surgeon, staff writer for The New Yorker, and prescient voice for health system transformation, has spent decades using his platforms to push for better outcomes, better value measures, and better coordination within health systems. While it is still unclear how this venture will unfold, an article in STAT offers an analysis of how Dr. Gawande’s past may predict the future of health care in this organization and beyond. Using his past writings as a guide, STAT posits that the following five principles will guide Gawande in his new role:

  • He is a staunch critic of fee-for-service payment and has often advocated for coordinated, value-based care and financing;
  • He will champion his longtime advocacy of using checklists; in fact, his book, “The Checklist Manifesto” extols the virtues of regimented, methodical practices as a means for reducing risk and ensuring quality;
  • He’s looking for ways to transform end-of-life care practices, moving away from the “treat-at-all-costs” medical culture, and toward making determinations about care centered around terminal patients’ needs and values;
  • He believes that universal coverage is foundational, and fundamental to solving long-term health crises, both in individual care and for systemic costs; and
  • The health care system is phenomenally difficult to change and even good ideas don’t always pan out, as Dr. Gawande learned when a checklist strategy he championed didn’t improve birth outcomes when it was implemented in a pilot project in rural India.



The California Department of Health Care Services (DHCS) announced two enrollment updates to the Cal MediConnect (dual eligible demonstration) program.

First, under a new pilot program for plan year 2019, participating Cal MediConnect plans will be able to pay independent brokers when a beneficiary chooses to enroll into Cal MediConnect similar to what is currently allowed in Medicare Advantage and in Dual Eligible Special Needs Plans (D-SNPs). Cal MediConnect plans will have to seek approval from DHCS to participate in the pilot, and will prioritize proposals from plans not operating any other Medicare Advantage plan in the county. The independent brokers will be paid through plan funds, and no additional funds will be available for this. The continuity of care provisions that allow beneficiaries to see their existing Medicare and Medi-Cal providers will apply for beneficiaries enrolled through this process. DHCS is working with CMS to provide additional guidance to selected plans on tracking and reporting independent broker enrollments, performing required training for independent brokers, and for oversight of the pilot. This new pilot program is deeply worrisome to advocates in the state, who are concerned about exposing Medicare-Medicaid beneficiaries to “potentially harmful broker misconduct accompanied by disruptions in care.” Led by Justice in Aging, consumer advocates signed on to a letter in opposition to this pilot program asserting that the use of an enrollment broker is a major rollback in a critical consumer protection. The letter is available here.

The second enrollment update is that DHCS will be seeking a waiver to new Medicare enrollment regulations that would limit Special Election Periods (SEP) for Cal MediConnect. Medicare recently finalized a regulation for 2019 with several changes, which included new limits on the continuous SEP for dual eligible beneficiaries. Based on stakeholder discussions, DHCS will seek a waiver to maintain the continuous SEP in calendar year 2018. California-based Justice in Aging, wrote to DHCS to encourage applying for the waiver as continuous SEP is a consumer protection fundamental to the Cal MediConnect demonstration program. The comment letter is available here.


MassHealth (Medicaid) is seeking comments on a concept proposal to the Centers for Medicare and Medicaid Services (CMS) for a “One Care 2.0” demonstration. This new demonstration would impact both of MassHealth’s integrated care programs for Medicare-Medicaid beneficiaries: the One Care demonstration project for the under-65 population and the Senior Care Options (SCO) program for the over-65 population. Using 1115A demonstration authority for a five-year period, MassHealth wants federal authority and flexibility to:

  1. grow and sustain enrollment in One Care and SCO using passive enrollment and fixed enrollment periods;
  2. align Medicare and Medicaid administrative processes and unify member communications, similar to the approaches used today in One Care;
  3. strengthen the fiscal stability of the One Care program for both the Commonwealth and federal government by updating One Care to more closely reflect the financial methodology used in the Medicare Advantage program, and by implementing a modified quality performance rating system specific to under-65eligible Medicare-Medicaid beneficiaries;
  4. use innovative approaches to ensure fiscal accountability and sustainability for the Commonwealth and federal government through value-based purchasing, increased transparency and data sharing, and an integrated calculation of the percent of combined Medicare and Medicaid funds that One Care and SCO plans spend on direct care for members (medical loss ratio); and
  5. enter into a shared savings agreement with CMS, in which both the Commonwealth and federal government share in savings resulting from One Care 2.0.

New York

The Medicare Right Center (MRC) submitted a proposal to the New York State Department of Health with recommendations for the vehicle that may replace the state’s dual eligible demonstration project, which is set to end at the end of 2019. MRC’s proposal details essential elements and is informed by its experiences with the Medicare and Medicaid population in New York and across the country. The submitted proposal incorporates input from consumer advocates, providers, health plans and Medicare-Medicaid beneficiaries. The proposal is available here.


In a new brief by the National Academy for State Health Policy (NASHP), author Robin Lunge, a Green Mountain Care Board member and former state Director of Health Care Reform, explores how Vermont’s transformation from a fee-for-service payment system to a value-based, multi-payer model designed to curb health care spending and improve care is faring. Specifically, she examines its lessons for states and private-sector accountable care organizations, including those related to the model’s design and to incentives for changing provider and patient behavior.


Tuesday, June 26 (1-2 p.m. Eastern) - Webinar: Enhancing Self-Efficacy in Persons Living with Dementia, presented by the American Society on Aging. Please register  for the webinar.   

Thursday, July 12 (2-3 p.m. Eastern) - Webinar: Where the Magic Happens: A Guide to Grassroots Organizing for Consumer-Driven Delivery Reform, presented by the Center for Consumer Engagement in Health Innovation. Please register  for the webinar.