Analytics

CMS Announces Primary Cares Initiative

On April 22, 2019, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Primary Cares Initiative (PCI), which will present eligible providers and other entities with the opportunity to engage in value-based payment and direct contracting payment models for primary care beginning in January 2020. CMS designed PCI to reduce expenditures and preserve or enhance quality of care for beneficiaries in Medicare fee-for-service (FFS). PCI is comprised of two tracks, Primary Care First (PCF) and Direct Contracting (DC). The PCF track, which builds on the Comprehensive Primary Care Plus (CPC+) initiative, is intended for individual primary care practices and seeks to reward providers for reductions in hospital utilization and total cost of care through performance-based payment adjustments. Also, under the PCF track, practices that specialize in serving high-need and/or seriously ill populations will receive adjusted payments to account for the populations served. Providers that participate in these models will qualify as participating in an Advanced Alternative Payment Model and be eligible to receive full bonus payments under CMS’s Medicare Incentive Payment System (MIPS).

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HMA MACPAC Report Published

A team of HMA colleagues including Sarah Barth, Sharon Silow-Carroll, Esther Reagan, Mary Russell and Taylor Simmons completed a study for the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) to examine care coordination requirements for several Medicare-Medicaid integrated care models.

The study’s final report, Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches, is posted to the MACPAC website.

The final report details state and federal managed care contract requirements for care coordination, summarizes stakeholders’ perspectives on care coordination based on structured interviews, and highlights promising care coordination practices and challenges for ensuring effective care coordination for dually eligible beneficiaries.

Medicaid Plan PMPM Rates Rise 0.3 Percent in 2018 for TANF/CHIP In 19 States, 4 Percent for Expansion, HMAIS Analysis Shows

This week, our In Focus summarizes the findings of an HMA Information Services (HMAIS) analysis of Medicaid managed care rates in 2018 versus 2017. The analysis represents HMAIS’ first attempt at what will be an annual tracking of Medicaid managed care rate increases, which we will expand upon and refine over time with input from our readers and the Medicaid community. Complete results, including spreadsheets showing underlying analysis, will be made available to HMAIS subscribers. For information on how to subscribe, contact Carl Mercurio.

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HMA Conducts Multi-Layered Study to Address Alarming Youth Suicide Trends Across Colorado

On January 3, 2019, Colorado Attorney General Cynthia H. Coffman released the study, Community Conversations to Inform Youth Suicide Prevention. The multi-layered study, conducted by HMA, analyzes and characterizes the trends and patterns in the fatal and non-fatal suicidal behaviors among young people in the four Colorado counties with the highest rates of youth suicide: El Paso, La Plata, Mesa, and Pueblo. The purpose of the study was to determine the best strategies for addressing and preventing youth suicide in Colorado and to see where the state’s efforts and dollars can be used most effectively.

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HMA Experts Aid Delivery System Transformation Efforts

Editor’s Note: This post was authored by Managing Principal Roxane Townsend, MD, and Senior Consultant Jeannine Hinton, LCSW, MHA.

HMA recently completed efforts to help the State of Louisiana and Louisiana State University (LSU) enter into a cooperative endeavor agreement with Ochsner LSU Health System of North Louisiana, a private nonprofit corporation.

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Exploring the Behavioral Health Independent Practice Association in an Era of Managed, Value-based Care

Editor’s Note: HMA Principals Karen Batia, David Bergman, Meggan Schilkie and Senior Consultants Meghan Manilla and Nicola Pinson contributed to this post. 

Across the country, behavioral healthcare is stretched thin and access to specialty care is a challenge. As value-based payment makes its way to the forefront, more than ever government entities, providers, payers and community-based organizations are exploring new avenues to meet shifting priorities and the requirements that accompany them.

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Medicaid Expansion Considerations For Non-Expansion States

This week, our In Focus section is led by Matt Powers, a Principal in our Chicago office, who worked with HMA colleagues to summarize the factors that non-expansion states weigh when considering whether or not to expand Medicaid under the Affordable Care Act.  Including the states where Medicaid expansion ballot initiatives passed, 37 states have chosen Medicaid expansion or are moving toward Medicaid expansion. More than 12 million newly eligible individuals are insured by state Medicaid programs through the expansion. Comments on recent ACA Court Ruling:

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Medicaid and Exchange Enrollment Update – September 2018

This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “September 2018 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on November 30, 2018. Additionally, we review 2018 Exchange enrollment data from the “Health Insurance Marketplaces 2018 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on April 3, 2018. Combined, these reports present a picture of Medicaid and Exchange enrollment in 2018, representing 73 million Medicaid and CHIP enrollees and nearly 12 million Exchange enrollees.

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Navigating CMS’ Proposed Medicaid Managed Care Regulations

This week’s HMA Weekly Roundup features an In Focus article from HMA Senior Consultants Amber Swartzell and Stephanie Baume (Indiana), who reviewed the Centers for Medicare & Medicaid Services (CMS) proposed Medicaid managed care regulations. On November 8, 2018, CMS released a proposed rule that would update several sections of the Medicaid and Children’s Health Insurance Program (CHIP) managed care rules, which were most recently amended in 2016. This much anticipated proposal, scheduled to appear in the Federal Register on November 14, 2018, focuses on “promoting flexibility, strengthening accountability, and maintaining and enhancing program integrity.” The key provisions of the proposed regulations are summarized below.

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