This week, our In Focus highlights a recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous HMA report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.
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2022 Star Ratings, An Historical Year
This week, our In Focus provides an analysis of 2022 Medicare Advantage (MA) Star Ratings, including a look at how regulatory changes during the COVID-19 pandemic resulted in a record number of Medicare plans receiving historically high scores. HMA Managing Director Anthony Davis and Principal Sarah Owens rely on data from the Centers for Medicare & Medicaid Services (CMS) to take a deep dive into ratings for nearly 500 Medicare plans serving 26.8 million members.
Center for Medicare and Medicaid Innovation: Recommendations for Future Direction
A recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous HMA report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.
The brief examines options for how CMMI could refine their approach to testing ideas for improving the Medicare program. HMA colleagues Jennifer Podulka, Yamini Narayan, and Lynea Holmes wrote the brief which was supported by Arnold Ventures.
HMA’s earlier brief examined the progress the Innovation Center has made in learning from Medicare-focused models during its first decade and raised questions to guide policymakers as they plan for the next phase of the Innovation Center’s work. In the new report, the team returns to those questions and offers potential answers.
The brief outlines seven pairs of competing goals and offers four recommendations that may, in part, help to balance these competing goals, as they are designed to increase the transparency of Innovation Center efforts and improve the likelihood that more models succeed in decreasing spending or improving quality. The recommendations include:
- The Department of Health and Human Services (HHS) should establish a National Healthcare Transformation Strategy
- CMMI should articulate a vision for how different models work together
- CMMI should tailor models to test ideas that address the largest areas of spending growth and key areas of quality concerns, including
- Include Part D in models
- Include Part C in models
- Promote primary care as a counterbalance to excessive low-value care
- Address social determinants of health and other drivers of quality and access disparities
- Congress and HHS should revisit the Physician-Focused Payment Model Technical Advisory Committee (PTAC)
Webinar Replay: Continuing the Path to Medicare-Medicaid Integration
This webinar was held on October 4, 2021.
Federal and state policy makers have long been working to expand enrollment in Medicare-Medicaid integrated care programs (ICPs). ICPs can advance independent living and health equity for individuals who are dually eligible for both programs. However, approximately only one in 10 dually eligible individuals was enrolled in an ICP as of 2019. To encourage ICP enrollment and retention, HMA identified 10 essential elements of ICPs centered around, informed by, and made available to dually eligible individuals. (See HMA Brief #3 and the brief fact sheet.)
During this webinar, HMA shared these 10 essential elements for establishing and simplifying ICPs specifically tailored to diverse individuals’ needs and preferences. Panelists involved in health justice and community-based healthcare offered practical next steps for advancing ICPs.
Learning Objectives
- Hear about the 10 essential elements for ICPs identified through interviews with diverse stakeholders
- Engage panelists to share their views on how to advance ICPs tailored around members’ needs
- Consider the types and level of investment required to advance the essential elements for ICPs
Speakers
- Arielle Mir, MPA, Vice President of Health Care, Arnold Ventures, Washington, DC
- Sarah Barth, JD, Principal, HMA, New York, NY
- Ellen Breslin, MPP, Principal, HMA, Boston, MA
- Dennis Heaphy, M.Div., M.Ed., MPH, Health Justice Policy Analyst, Disability Policy Consortium, Malden, MA
- Linda Little, MBA, RN, CCM, President and CEO, Neighborhood Service Organization (NSO), Detroit, MI
HMA briefs on Medicare-Medicaid integration
This issue brief from Health Management Associates, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals is part of a multi-phased research initiative to increase enrollment in integrated care programs (ICPs)[1] that meet full benefit dually eligible individuals’[2] needs and preferences. Dually eligible individuals have a range of chronic conditions and disabilities requiring both Medicare and Medicaid services, which makes integrated programs important to their lives.
For a succinct overview of the essential elements and policy recommendations, please access the brief fact sheet. For a full discussion of the elements and policy recommendations, please access the full brief.
The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.[3]
For further information or questions, contact Sarah Barth, Ellen Breslin or Samantha DiPaola.
[1] Integrated Care Programs (ICPs): For this research, we defined ICPs as financing and care delivery organizing entities or programs that coordinate and integrate Medicare and Medicaid-covered services and supports for dually eligible individuals.They include the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative (FAI) capitated and fee-for-service models; the Program of All-Inclusive Care for the Elderly (PACE); Medicare Advantage (MA) Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Medicaid Managed Long-Term Service and Supports Program (MLTSS) managed care organizations and aligned MA dual eligible special needs plans (D-SNPs); and state-specific programs that may be proposed to CMS.
[2] Dually Eligible Individuals: When using the term dually eligible individuals, we are referencing Medicare-Medicaid full benefit dually eligible individuals (FBDEs), those who qualify for full Medicaid benefits.
[3] Narda Ipakchi was formerly a Senior Consultant with HMA.
Medicare-Medicaid integration: key elements and policy recommendations for dual eligible care programs
This week, our In Focus section releases a new brief from Health Management Associates, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals. The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.[1]
State efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs
This week, our In Focus section reviews a new paper from Health Management Associates,State Efforts to Integrate Care Across Medicaid Fee-for-Service Long-Term Services and Supports and Medicare Advantage Dual Eligible Special Needs Plans by Sarah Barth, Rachel Deadmon and Julie Faulhaber. Funded by UnitedHealthcare, this paper outlines approaches taken by Medicaid programs seeking to coordinate Medicare and Medicaid services for dually eligible individuals without first implementing standalone Medicaid managed long-term services and supports (MLTSS) programs.
HMA brief examines state efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs
Funded by UnitedHealthcare, the issue brief, State Efforts to Integrate Care Across Medicaid Fee-for-Service Long-Term Services and Supports and Medicare Advantage Dual Eligible Special Needs Plans, outlines approaches taken by Medicaid programs seeking to coordinate Medicare and Medicaid services for dually eligible individuals without first implementing standalone Medicaid managed long-term services and supports (MLTSS) programs.
Authors are Sarah Barth, Rachel Deadmon and Julie Faulhaber.
HMA examines CMS Innovation Models over the past decade
A new issue brief and accompanying data set by HMA colleagues examines models implemented by the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (The Innovation Center) over the past decade and provides evaluation of the findings.
Which Medicare changes should continue beyond the COVID-19 pandemic? Four questions for policymakers
In an issue brief prepared for The Commonwealth Fund and The SCAN Foundation, HMA consultant Jennifer Podulka and Vice President Jonathan Blum, analyze the temporary COVID-19-related changes to Medicare regulations, described the benefits and risks of the changes, and offered a framework to support policymakers’ decisions on the future of these temporary policies.
HMA authors report examining future of COVID-19 Medicare regulation changes
A new Issue Brief, authored by Jennifer Podulka and Jon Blum, examines the many changes to Medicare regulations put in place during the COVID-19 pandemic. The brief, Which Medicare Changes Should Continue Beyond the COVID-19 Pandemic? Four Questions for Policymakers, tracks and categorizes the regulatory changes, describes the benefits and risks of the changes, and establishes a framework to support policymakers’ decisions regarding the future for the changes after the pandemic ends.
CMS proposed rule to repeal market-based MS-DRG weight methodology for inpatient hospitals
This week, our In Focus section reviews the key provisions of the Centers for Medicare & Medicaid (CMS) Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (CMS-1752-P), which includes Medicare payment updates and policy changes for the upcoming FY, with a comment deadline of June 28, 2021. This year’s proposed rule includes several proposals the hospital industry should carefully consider. In particular, the Biden Administration has proposed to: