Is your organization ready to become an integrated delivery system?

For providers, transitioning from volume- to value-based care is no easy task. You are likely facing a growing number of pressures that are becoming increasingly difficult to manage. These could include community/political pressures, primary care shortages, medical staff competition, and incentives to measure and manage care quality and total costs and address non-clinical aspects of health. Additional demands include risk sharing arrangements, audits, and pitches from vendors. Aligning your facilities, programs and services into a fully integrated delivery system can seem like a daunting task. But HMA can help.

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Medicaid and Exchange Enrollment Update

This week, we reviewed updated reports issued by the Department of Health & Human Services (HHS) on Medicaid expansion enrollment from the “September 2016 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on December 1, 2016. Additionally, we review 2016 Exchange enrollment data from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief, “Health Insurance Marketplace 2016 Open Enrollment Period: February 2016 Enrollment Report,” and 2017 enrollment snapshot data through December 19, 2016, from the Centers for Medicare & Medicaid Services (CMS). Combined, these reports present a picture of Medicaid and Exchange enrollment at the end of 2016, with a look at progress towards 2017 Exchange enrollment.

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Virginia JLARC Issues Report on Medicaid Spending Management

This week, our In Focus section comes to us from HMA Principal Barbara Markham Smith, JD, of our Washington, DC office. On December 12, 2016, Virginia’s Joint Legislative Audit and Review Commission (JLARC), the audit arm of the General Assembly, issued findings from its two-year review of the Department of Medical Assistance Service’s (DMAS’s) management of the Medicaid program. In a review of DMAS’s performance that largely foreshadows Medicaid reforms to be implemented in 2017-2018, JLARC notes that inflation-adjusted Medicaid spending in Virginia, per enrollee, remained essentially flat from FY2011 to FY2015. Program spending increases came from growing enrollment due to expanded outreach activities and the addition of new waiver slots for people with intellectual and developmental disabilities.  The growth in total spending (as opposed to per capita spending), amounted to average annual cost increases of 8.9 percent over the past 10 years. Services for individuals with disabilities accounted for the lion’s share of cost increases, according to a budget report released earlier this year. Medicaid spending accounted for 22 percent of Virginia’s general fund budget in FY2016. 

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Oklahoma Releases Soonerhealth+ RFP

This week, we reviewed the Oklahoma Health Care Authority’s (OHCA’s) request for proposals (RFP) for a new statewide Medicaid managed care program for individuals who are aged and individuals with disabilities (ABD). The program, called SoonerHealth+, will provide managed acute care, behavioral health, and managed long-term services and supports (MLTSS) to roughly 155,000 members, to be phased in over two years beginning in April 2018. Based on state fiscal year 2014 data, SoonerHealth+ spending per year could exceed $2.5 billion when fully implemented. Proposals are due on February 28, 2017.

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Revisiting Congressman Tom Price’s ACA Repeal Legislation

This week, we revisited 2015 legislation introduced by Georgia Congressman Tom Price, who was announced this week as President-elect Donald Trump’s nominee for Secretary of the U.S. Department of Health & Human Services (HHS). Representative Price’s 2015 bill, H.R. 2300, known as the “Empowering Patients First Act,” included a full repeal of the Affordable Care Act (ACA) as well as all health care provisions in the related Health Care and Education Reconciliation Act passed in 2010. A version of the Empowering Patients First Act has been introduced in Congress every year since 2009. Below, we review Representative Price’s proposed replacement plans around insurance coverage, and provide brief summaries of some of the other provisions in the legislation.

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