In October 2021, the Center for Medicare & Medicaid Innovation (the Innovation Center) published a white paper outlining its strategic vision and direction of the healthcare delivery system for Medicare and Medicaid beneficiaries through 2030. This included a focus on high-quality primary care, which they identify as the foundation of our health system, to achieve equitable, whole-person, integrated care and outcomes.
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This webinar was held on March 24, 2022.
Since 2018, the federal government has granted more than $5 billion in State Opioid Response (SOR) funds aimed at supporting evidence-based prevention, treatment, and recovery of opioid use disorder (OUD). The most successful state initiatives have focused on driving healthcare delivery system changes designed to increase timely, consistent, high-quality access to treatment and support services, including the use of medication assisted treatment (MAT). During this webinar, speakers showcased best-in-class efforts by states like California, Delaware, and Illinois to leverage SOR funding and achieve measurable, system-wide improvement in OUD treatment and outcomes.
- Understand why a focused approach to the use of SOR funding is needed to drive delivery system transformation and measurable improvement in OUD treatment outcomes
- Learn how California and Illinois are utilizing a “learning collaborative model” to increase the use of MAT among incarcerated individuals
- Understand Delaware’s statewide approach to SOR and how building a synergistic and informed provider network is a central strategy
- Learn how to replicate successful SOR models, with the ultimate goals of increasing access to timely, consistent care
Marsha Johnson, Managing Principal, HMA, Philadelphia, PA
Bren Manaugh, Principal, HMA, Austin, TX
Kathleen Monahan, Project Director, State Opioid Response, Illinois
Brent Waninger, Chief, Workforce Development and Education, Project Coordinator, State Opioid Response, Delaware
This week our In Focus section reviews scenarios in which the federal Public Health Emergency (PHE) may expire. In the weeks ahead, the U.S. Secretary of Health and Human Services (HHS), Xavier Becerra, will be faced with the decision of whether to extend the PHE or to allow it to expire. Dozens of critical waivers and coverage flexibilities are currently linked to the federal PHE and have enabled patients, providers, and payors to receive, deliver, and pay for health care for nearly two years. To date, the PHE has been extended eight times, each for the maximum allowed 90 days. However, declining COVID-19 infection rates and actions by state governors to relax COVID-19-related public health measures have renewed pressure on the Biden Administration to signal how they will choose to act on April 16, 2022 when the current federal PHE expires.
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.
This week our In Focus section reviews the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center’s newly announced model – Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH). CMS will accept applications from organizations interested in participating and is particularly interested in partnering with provider-led organizations and similar groups with direct patient care experience and a strong track record serving underserved populations that focus on primary care to better manage Medicare beneficiaries’ health. Applications are due by April 22, 2022.
This week, our In Focus section reviews the Iowa Health Link request for proposals (RFP) for Medicaid managed care organizations (MCOs) to serve the state’s traditional Medicaid program, the Children’s Health Insurance Program (CHIP) known as Healthy and Well Kids in Iowa (Hawki), and the Iowa Health and Wellness Plan (IHAWP). The RFP was released by the Iowa Department of Human Services on February 17, 2022. Contracts are set to begin July 1, 2023, and are worth approximately $6.5 billion annually.