Health Innovation Highlights: September 21, 2018

Full Edition

FROM THE CENTER & OUR PARTNERS

We’re Hiring!

The Center is hiring a Consumer and Community Engagement Advisor. This new position will build collaborative relationships with clients including health plans and providers, hospitals, state agencies and others serving vulnerable populations. In particular, this person will assist clients in developing and implementing effective systems of community engagement in health care. The advisor will provide skill-building training and strategic guidance to support client efforts aimed at engaging consumers in order to improve health care services and the overall health of vulnerable populations. A bilingual and/or bicultural background is highly desirable. Please pass along this announcement to individuals you think might be a good fit.

Finding Center Resources Just Got Easier!

If you’ve spent time seeking out items of interest on the Center’s website by wading through the wide variety of policy briefs, comment letters, toolkits, blog posts and more that we’ve published over the past few years, we have good news! We have rolled out a new Resources page that allows visitors to more easily find materials most relevant to their interests. Simply click on “RESOURCES” in the top menu of any page on the website to visit the new page and use the topic filter checkboxes to refine the listing. Please visit the new page and give it a spin!  We welcome your feedback and suggestions for how to make this new feature work even better.

Center Comments on Physician Fee Schedule Proposed Rule

On Sept. 10, the Center submitted comments to CMS on the Physician Fee Schedule Proposed Rule. This Proposed Rule provides CMS with an important opportunity to ensure that Medicare payments accurately reflect the time and effort needed to appropriately care for beneficiaries and provide them with the services necessary to improve health outcomes or maintain quality of life. It impacts what kinds of services Medicare beneficiaries receive, how much time their providers spend with them and their out of pocket costs, among other things. The Center’s comments addressed a variety of topics relevant to the Proposed Rule, including:

  • Technology-Based Consultations
  • Evaluation and Management Visits
  • Part B Drugs
  • Bundled Payment
  • Substance Use Disorders
  • The Quality Payment Program
  • Transparency

NOTEWORTHY NEWS & RESOURCES

New Report Highlights the Lack of Data on the LTSS Needs of Younger Adults with Disabilities

A new report published by the Long-Term Quality Alliance (LTQA), with support from the Commonwealth Fund, reveals the gaps in research and policy understanding about differences in needs between the older and younger adult populations who rely on long-term services and supports (LTSS). The authors discuss how this gap in knowledge has contributed to a disproportionate focus on the LTSS needs of older Americans and impedes the ability of policymakers to make improvements to the delivery and financing of LTSS for adults with disabilities under 65. Final recommendations include identifying instruments to use in a comprehensive study of people with disabilities across the lifespan, developing a legislative proposal to appropriate funds for a national survey on disability and LTSS need, and conducting a pilot survey for a subgroup of younger adults with disabilities.

Independent Evaluation of ACO Performance Finds ACO Savings Double CMS Estimate 

An independent evaluation of Medicare Shared Savings Program (MSSP) ACOs found that savings were nearly twice the amount estimated by CMS. In the largest-ever study of ACO performance based on Medicare claims, evaluators assert that the benchmarking methodology used by CMS to calculate savings understates the actual savings generated by the ACOs.

States Look to Advance Access to Quality Palliative Care

The National Academy for State Health Policy (NASHP) is working with state leaders to see how palliative care programs can be improved and expanded. Palliative care has been shown to have a large return on investment by reducing unnecessary hospitalizations and may be an important mechanism for improving care quality and controlling cost for patients with serious illness. NASHP will be working over the next two years to identify promising practices, develop state recommendations, and form model legislation and Medicaid managed care contract language for states looking to advance palliative care.  

ACAP Plans Work to Address Health and Housing Gap for Older Adults

In an opinion piece in The Hill Margaret Murray, CEO of the Association for Community Affiliated Plans (ACAP) describes how the 62 plans in ACAP are investing in innovations to address social determinants, even if they fall outside the traditional bounds of Medicaid health benefits. The health and housing gap — especially for seniors — is far larger and more expensive than most would care to admit. By 2035, more than 79 million Americans will be over the age of 65. An estimated 70 percent of these older adults will need long-term care. This unprecedented growth, combined with an acute shortage of affordable housing, has profound public health and housing implications.

ACAP’s Community Care Settings Program reflects growing recognition by Medicaid health plans that health care doesn’t end at the clinic door, and seeks to solve problems such as housing and transportation that influence their members’ ability to get and stay well.

STATE HIGHLIGHTS

Connecticut

The Centers for Medicare and Medicaid Services has awarded the state of Connecticut a $12.2 million grant to establish its first statewide clinical health information exchange (HIE). The Connecticut HIE will ensure that the state’s Office of Health Strategy can more quickly collect data on racial, ethnic and gender health disparities, and allow providers to share clinical and diagnostic data more efficiently. It is expected that these innovations will improve patient care, particularly for the 800,000 residents utilizing Medicaid, allow for more precise corrections/interventions in inequitable care and outcomes, and enable the state to better evaluate provider performance.

Louisiana

The Louisiana Department of Health (DPH) is moving forward with its payment innovation plan targeting low-income patients suffering from Hepatitis C. Under the plan, Louisiana will pay a pharmaceutical manufacturer a lump sum over a three-to-five year period based on the state’s current spending for Hepatitis C medication for Medicaid and incarcerated populations in exchange for unlimited access to the treatment. There are nearly 35,000 Louisianans on Medicaid with Hepatitis C, but there are likely thousands of additional residents who are not being treated. DPH officials say that the high cost of the medication is prohibitive to many residents, but that the state’s procurement of the necessary drugs could help incentivize the identification of untreated patients and go a long way toward eliminating the virus that causes Hepatitis C.

Pennsylvania

The Pennsylvania Departments of General Services (DGS) and Human Service (DHS) have cancelled a procurement process for an independent enrollment broker for LTSS that has been going on for almost a year. In a press release announcing the cancellation, DHS noted that instead, the department would be soliciting feedback on the “structure and requirements for a future independent enrollment broker.” The announcement signals an opportunity for advocates to provide recommendations and input on both the development of a new RFP and the future of LTSS in the state.

KEY DATES

Wednesday, Sept. 26 (1-2 p.m. Eastern) - Webinar: Reframing Aging in the Healthcare Sector, presented by the American Society on Aging. Please register for the webinar.  

Wednesday, Sept. 26 (1:30-3 p.m. Eastern) - Webinar: State Leadership on Complex Care, presented by The National Center for Complex Health and Social Needs in partnership with the National Governors Association. Please register for the webinar.    

Tuesday, Oct. 30 (2:30-3:30 p.m. Eastern) - Webinar: Addressing Social Determinants of Health in Medicaid Managed Care, presented by Manatt Health. Please register for the webinar.