Efforts to reduce America’s opioid-related overdose deaths are being hampered by glaring inconsistencies in U.S. policies and practices from one region, health system, and community to another. So states a new Well Being Trust brief, “Naloxone for Overdose Reversal: Challenges and Opportunities,” written by HMA consultants Barry Jacobs and Helena Whitney, released September 15, 2022. The 10-page, intensively researched report also makes four policy recommendations calling for easier access to naloxone for providers and consumers, as well as more consistent naloxone prescribing and community distribution practices throughout the country.
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With 1 in 5 children experiencing a mental health condition every year and only 54 percent of non-institutionalized youth enrolled in Medicaid or CHIP receiving mental health treatment, the HMA team of Caitlin Thomas-Henkel, Uma Ahluwalia, Devon Schechingerand Debbi Witham have authored the first in a series of briefs focused on enhancing the youth behavioral health system. This brief, Bolstering the Youth Behavioral Health System: Innovative State Policies to Address Access & Parity, explores state policy levers to advance access and availability of behavioral health services (encompassing mental health and substance use disorders) for youth.
In a series of issue briefs outlining Medicare savings proposals, Jennifer Podulka examines federal budget pressures and impending insolvency of the Medicare Trust Fund that will require Congress to choose between reducing provider or Medicare Advantage plan payments, increasing dedicated income, modifying beneficiary cost sharing, or some combination of these options.
Successful Centers for Medicare & Medicaid Services Innovation Center models, temporary regulatory flexibilities implemented in response to the COVID-19 public health emergency, and other recent Medicare policy changes inform new savings options for policymakers to consider.
The issue briefs were prepared for Arnold Ventures and will be used to drive discussion and planning. Five novel Medicare savings proposals include:
California Health Care Foundation released a new study authored by the Edrington Health Consulting, an HMA company, Investing in Primary Care: Why it Matters for Californians with Medi-Cal Coverage, that highlights the critical role primary care plays for patients in Medi-Cal. The study encompasses 5.4 million Californians enrolled in Medi-Cal managed care, or nearly half of all Medi-Cal enrollees in 2019, and finds greater investment in primary care is generally associated with better quality of care, patient experience, and plan rating. Furthermore, the study provides an important baseline for understanding how greater investment in primary care can improve quality and equity; this is particularly important as California expands Medi-Cal to include all income-eligible Californians, regardless of immigration status. This analysis comes as California is taking significant steps toward ensuring primary care teams, including physicians, nurse practitioners, physician assistants, community health workers, behavioral health staff and others play a greater role in the health care delivery system.
The third issue brief, in a series by HMA and National Council colleagues that examines the workforce crisis facing the country’s behavioral health system, highlights the access and service delivery challenges presented and exacerbated by health disparities and inequities.
The brief focuses on the need to recruit, train, and retain a diverse workforce in order to reduce behavioral health disparities and engage populations with historic and structural disparities, in order to build trust with providers and in the overall healthcare system.
Outlining challenges and actionable solutions, the brief points to the Certified Community Behavioral Health Clinic (CCBHC) model as an opportunity for states and provider organizations to partner and address health disparities and social determinates of health for underserved and marginalized populations.
Additional briefs in this series are Behavioral Health Workforce is a National Crisis: Immediate Policy Actions for States and Immediate Policy Actions to Address the National Workforce Shortage and Improve Care
The following HMA colleagues contributed to this series: Uma Ahluwalia, Heidi Arthur, Angela Bergefurd, Cammie Cantrell, Nora Carreras, Suzanne Daub, Gina Eckart, Gina Lasky, Juliet Marsala, Emma Martino, Sandra Oxley, Deb Peartree, Erica Reaves, and Doris Tolliver.
A new person-centered assessment framework and issue brief, authored by HMA experts in conjunction with Manatt Health, examine the temporary regulatory Medicare and Medicaid flexibilities implemented during the COVID-19 public health emergency (PHE) and aimed at ensuring access to care for older adults and people with chronic conditions and disabilities.
As these temporary flexibilities are currently set to expire in April 2022, the report provides insight and guidance for policymakers as they assess the impact these regulatory policy changes are having on advancing person- and community-centered care and consider possible permanence of these changes.
The framework is designed to help facilitate these conversations and decisions and assess the potential for continuation of the regulatory flexibilities to advance person- and community-centered care, facilitate access to care in the least intensive or least restrictive setting, and better align Medicare and Medicaid program rules.
HMA colleagues Jennifer Podulka, Yamini Narayan, and Keyan Javadi contributed to the framework and research.
An issue brief released today outlines new Medicare payment models that offer greater flexibility and aim to shift more care to primary care models, moves that can improve quality and reduce costs. HMA authors, Jennifer Podulka, Yamini Narayan, and Lynea Holmes found the two newest primary care payment models, Global and Professional Direct Contracting (which will be re-branded as Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) beginning January 1, 2023) and Primary Care First offer more flexibility than previously released approaches and represent a promising step forward for primary care.
The report, Increasing Medicare’s Investment in Primary Care, also notes that to increase the likelihood that models achieve overall cost savings and/or quality improvement, one option for the Center for Medicare and Medicaid Innovation is to test approaches that place greater value on primary care and give primary care providers greater flexibility to tailor care for people outside of a fee-for-service system. These changes could improve people’s access to care, the quality of care received, and quality of life.
Residents in nursing facilities faced higher infection rates and worse overall care experiences during the COVID-19 public health emergency highlighting long-standing concerns about the quality and cost-effectiveness of nursing facility care, especially for residents of color.
In a recent issue brief published by the Milbank Memorial Fund that HMA COO Chuck Milligan co-authored with Kate McEvoy, a program officer with Milbank, examined disparities in access, levels of care, and resident outcomes, and provided recommendations and guidance for the Centers for Medicare and Medicaid Services (CMS) on future approach to federal policy in nursing facilities.
The brief, A Call for Federal Action to Improve Nursing Facilities, suggests CMS take the following steps to improve nursing facility oversight and care:
- Endorse linkage of any further public health emergency-related funding or other federal financial reimbursement to quality improvement.
- Align Medicare and Medicaid efforts to promote payment policies that are based on risk adjustment for complex care and incorporate value-based payment principles, eliminate unintended consequences of federal policies such as routine approval of nursing home bed taxes, and adopt a common foundation of quality measures.
- Expand existing guidance on rebalancing long-term services and supports.
- Enhance conditions of participation for nursing homes and hospitals by including structural measures such as census and staff turnover.
- Build out existing mechanisms like Care Compare to enhance public transparency, availability, and usability of cost report and ownership information and to provide timely and complete information on nursing facility citations.
Examining the more than 3 million non-elderly poor adults in states without Medicaid expansion, the HMA team of Matt Powers and former HMA colleagues Nora Leibowitz and Jack Meyer, have authored an issue brief proposing a local health insurance option to fill gaps for these individuals who frequently lack access to meaningful healthcare.
The brief, Considerations for a Local Health Insurance Option in Medicaid Non-expansion States, published by the Milbank Memorial Fund, recognizes the critical role local entities and providers play in providing care and proposes a Local Choice Option, could:
- Provide a comprehensive insurance product that promotes appropriate access to healthcare and better health outcomes
- Repurpose funding now used only for direct care to provide healthcare more efficiently
- Support local customization and create an alternative to an open-ended entitlement program in states where that is not currently politically tenable
The brief concludes a Local Choice Option would be a sound investment with the potential for quick implementation and benefits of health insurance not currently available to people living in poverty in non-expansion states.
A recent report examines the importance of behavioral healthcare (BH) and its ability to improve outcomes and reduce costs when integrated in meaningful ways with medical services, especially primary care.
An HMA team of behavioral health experts, including Annalisa Baker, Ann Filiault and Josh Rubin, published the report, The Value of Community Behavioral Health Providers & Their Networks with the New York State Council for Community Behavioral Healthcare and the New York State Collaborative BH Independent Provider Associations (IPA).
Patients with mental health and substance use disorders are heavy utilizers of healthcare services and Medicaid spending is nearly four times the cost compared to other enrollees. By developing and working within IPAs, providers can enable community healthcare and come together to establish systems of population care, build technology infrastructures, develop needed workforce and work toward value-based healthcare.
New York state is investing in the development of behavioral IPAs through the Behavioral Health Value Based Payment Readiness Program. The report outlines policy recommendations for promoting BH IPAs and maximize their positive impacts including:
- Facilitate access to data for BH IPAs by enabling them to access the Medicaid Data.
- Warehouse and including data sharing requirements in future managed care contracts.
- Include BH IPAs in network adequacy definitions for Medicaid MCO Contracts to ensure that Medicaid beneficiaries have access to integrated behavioral health care and revise the definition of valid VBP Level 2 or 3 arrangements to include BH IPAs.
- Fund a Phase 2 Infrastructure Program to provide the BH IPAs additional time to realize the goals of the BH VBP Readiness Program.
The National Council for Mental Wellbeing (National Council) and HMA have released the second in the series of three issue briefs examining the ongoing, and exacerbated, workforce and staffing crisis facing behavioral health services providers and facilities.
The brief, Immediate Policy Actions to Address the National Workforce Shortage and Improve Care, focuses on clinical transformation and provides short-term recommendations to support states in addressing the workforce shortages, provider burn-out, recruitment and retention.
- Adopting transformative clinical approaches and team-based care
- Identifying short-term actions and developing long-term strategies for improvement
- Expanding the workforce to build a more robust provider pipeline
- Increase adoption of in-person/telehealth hybrid models
HMA and the National Council colleagues contributed to the briefs and surrounding research.
A recently completed analysis of the impact of Medicaid managed care on key quality indicators found managed care organizations (MCO) outperformed fee-for-service (FFS) and primary care case management (PCCM) programs for both Child and Adult Core Set measures, once the data was normalized with respect to beneficiary distribution in each model.