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Report examines the value of community behavioral health providers and their networks
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.
California releases Medi-Cal managed care RFP for three plan models in 21 counties
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.
Webinar replay: summary and implications of the 2023 Medicare Advantage advance notice
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.
Learning Objectives
- 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.
HMA Speakers
Thomas Grivakis, Senior Consulting Actuary, Wakely
Rachel Stewart, Consulting Actuary, Wakely
Expanding Access to CenteringPregnancy Group Care Through Telehealth
BACKGROUND
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 patientprovider 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.
APPROACH
CHI engaged HMA to assist in responding to acute operational concerns for practices forced to abruptly implement telehealth during the onset of the COVID-19 pandemic. Dr. Margaret Kirkegaard, a family physician who provides prenatal care in clinical practice and is experienced in telehealth implementation projects, helped the CHI team respond to the needs of communities and families by expanding access to CenteringPregnancy group prenatal care through telehealth.
Based on that experience, CHI and HMA worked to develop a virtual model for CenteringPregnancy group prenatal care based on the existing evidence for telehealth prenatal care and the experience of current Centering providers.
RESULTS
The team developed a CenteringPregnancy Virtual Playbook with multiple provider and patient tools that help Centering sites establish a clinically appropriate cadence of telehealth and in-person visits, perform self-assessment via telehealth (e.g. home blood pressure monitoring), and manage group interactions through a telehealth platform. This work has the power to support families and providers and expand access to this critically necessary model of care.
Strengthening MAT Processes and OUD Care in Emergency Departments
THE CLIENT
Hospital Sisters Health System (HSHS), St. Nicholas Hospital, Sheboygan, Wisconsin
BACKGROUND
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.
THE CHALLENGE
Many individuals with OUD are seen in the emergency department (ED) due to overdose attempts, OUD related conditions like skin infections, or other medical issues where they acknowledge opioid use. However, most EDs are not prepared to initiate lifesaving, evidence-based treatment for OUD in the form of Medication Assisted Treatment (MAT).
HSHS, St. Nicholas Hospital, honoring their Franciscan tradition to provide holistic care with special attention to the most vulnerable individuals, committed to tackling the OUD issue head on.
APPROACH
With help from a team of HMA clinicians including a primary care physician, an addictionologist, emergency medicine clinicians, and a social worker, HSHS St. Nicholas Hospital applied for a grant from the Wisconsin Department of Health Services. The grant funds were used to strengthen their processes to initiate MAT in the ED, connect individuals with OUD with peer recovery specialists directly in the ED, and develop timely referrals for outpatient continuation of MAT.
The HMA team of Margaret Kirkegaard, MD, Shannon Robinson, MD, Scott Haga, PAC, Shelly Virva, LCSW, and Corey Waller, MD performed an initial assessment of ED processes for HSHS St. Nicholas Hospital, facilitated development of electronic medical record (EMR) tools for OUD order sets and referrals, and helped the hospital identify and tackle barriers to more robust MAT prescribing.
HMA also prepared and delivered a series of OUD educational modules that were tailored to individual clinical disciplines including didactic webinars and short, educational videos designed to fit the reality of a busy ED during a global pandemic.
RESULTS
HSHS St. Nicholas Hospital, with HMA’s continued assistance, is currently working on strengthening their OUD clinical processes and expanding MAT initiation in the ED to other HSHS hospitals and neighboring hospital systems.
LEARN MORE ABOUT THE PROJECT: www.stnicholashospital.org/opioid
CMS payment notice signals shift in COVID-19 policies for Medicare Advantage, Part D
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.
Delaware Releases Medicaid Managed Care RFP
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.
Second behavioral health issue brief focuses on workforce crisis and call for immediate action
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.
Recommendations include:
- 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.