This week, our In Focus section reviews the California Medicaid (Medi-Cal) managed care request for proposals (RFP) released by the California Department of Health Care Services (DHCS) on February 9, 2022. DHCS is procuring contracts for commercial plans for three of the Medi-Cal managed care plan models in 21 counties, serving approximately 3 million beneficiaries. Contracts will be awarded to one managed care organization (MCO) in each of the Two-Plan model counties, two MCOs in each of the geographic managed care (GMC) model counties, and two MCOs in each of the Regional model counties. This procurement is the largest released by California, rebidding contracts for commercial plans statewide.
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This webinar was held on February 22, 2022.
The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C/D Payment Policies, which proposes important changes in plan payments, risk adjustment, Star Ratings, and other key financial and regulatory requirements for 2023.
During this webinar, consultants from Wakely Consulting Group, an HMA Company, provided an overview of the proposed changes, with an emphasis on the likely impact that the new rates and policies will have on Medicare Advantage bids, membership growth, quality, and strategy. Speakers also touched on other recent public statements from federal regulators that could point to additional future changes for Medicare Advantage plans.
- Understand how the proposals in the Advance Notice will impact Medicare Advantage payment rates in 2023.
- Learn about updates to payment models and risk-adjustment methodologies, including a new effort to engage Medicare Advantage plans in value-based models that transform care.
- Find out how new initiatives to account for how well plans address equity and social determinants of health will impact Star Ratings.
- Understand the growth prospects for Medicare Advantage, including a look at how COVID-19 continues to affect plan membership growth, financial risk, and profitability.
Thomas Grivakis, Senior Consulting Actuary, Wakely
Rachel Stewart, Consulting Actuary, Wakely
Poor birth outcomes, especially for communities of color, are a persistent health issue for our country. While there is no “cure” for preterm birth, the leading contributor to poor birth outcomes, group prenatal care is an evidence-based practice to reduce pre-term birth, especially for urban African American communities.
Group prenatal care provides a host of other benefits including improved breastfeeding rates, enhanced parental knowledge, and better pregnancy spacing. In addition, decreasing preterm birth provides tremendous cost savings.
The Centering Health Institute (CHI) has developed a successful model of group prenatal care called CenteringPregnancy™. CenteringPregnancy empowers patients, strengthens patient-provider relationships, and builds communities through three main components of health assessment, community building, and interactive learning delivered as a series of group visits with pregnant individuals at similar gestational age.
While more prenatal providers are offering Centering as a model of care, not every pregnant individual has access to this model. Maternity care in rural America is facing a crisis in access, and the COVID-19 pandemic required organizations to shift to care delivered through telehealth.
Download to read the approach and results.
The prevalence of opioid use disorder (OUD) and the resultant harms from this disorder continue to escalate in the United States. The CDC’s National Center for Health Statistics released a report noting that in 2020, drug overdose deaths in the United States increased by nearly 30% over the previous year, reaching an all-time high of more than 100,000. The majority of these deaths are attributable to opioids.
Download the read the approach and results.
This week our In Focus section reviews the Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies issued by the Centers for Medicare & Medicaid Services (CMS) on February 1, 2022. The Advance Notice includes proposed updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2023. It also shows CMS’ updates to Part D benefit parameters. Comments are due by 6:00 PM EST on March 4, 2022. The final Rate Announcement will be published by April 4, 2022.
This week our In Focus section reviews the Delaware request for proposals (RFP) for Diamond State Health Plan (DSHP) and Diamond State Health Plan Plus (DSHP Plus), the state’s Medicaid managed care programs. The RFP was released by the Delaware Department of Health and Social Services (DHSS), Division of Medicaid and Medical Assistance (DMMA) on December 15, 2021.
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.
This webinar was held on February 15, 2022.
In 2020, state and federal government spending on Medicaid was $646 billion, with just over half going to Medicaid managed care programs and the rest to fee-for-service (FFS), primary care case management (PCCM), and other models. Despite the large investments, little evidence exists on differences in quality between the various models. Using the 2019 CMS Adult and Child Core Set Quality Measures, HMA normalized performance data across states to compare outcomes between managed care, FFS and PCCM. During this webinar, HMA consultants discussed the findings, which were published in an HMA white paper in November 2021.
- Understand how the different Medicaid delivery models performed on quality measures from the 2019 Adult and Child Core Set.
- Learn more about the Adult and Child Quality Measure Core Set and why the 2019 dataset provides one of the first opportunities to make valid comparisons between the Medicaid delivery models.
- Find out how this research could be expanded upon in the future to assess the key factors that drive higher quality and better performance in population health for low-income individuals.
- Explore the broader implications of this research for policymakers and state Medicaid officials.
Anthony Davis, Managing Director, Quality and Accreditation Services, Portland, OR
David Wedemeyer, Principal, Los Angeles, CA
Joe Moser, Principal, Indianapolis, IN
Beth Kidder, Managing Principal, Tallahassee, FL