This week, our In Focus section reviews the Centers for Medicare & Medicaid Services (CMS)-issued Fiscal Year (FY) 2020 Medicare Part A proposed rules. Between April 17 and April 23, 2019, the CMS issued the proposed rules for general acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), the skilled nursing facility (SNF) prospective payment system (PPS), the Inpatient Rehabilitation Facility (IRF) PPS, the Long-Term Care Hospital (LTCH) PPS, the Hospice PPS, and the Inpatient Psychiatric Facility (IPF) PPS. These proposed regulations include annual payment rate changes and other proposed policy changes. Comment deadlines for these rules vary.
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Engagement with community-based organizations key to achieving health equity & wellness for Medicaid populations
A new issue brief from AcademyHealth, in partnership with Health Management Associates (HMA) and the Disability Policy Consortium (DPC), showcases the vital role that community-based organizations (CBOs) can play in advancing health equity and wellness for individuals and communities in Medicaid payment and care delivery system reform.
The brief provides five key lessons from CBOs in New York City and reactions to those lessons from CBOs in Massachusetts. Together, these perspectives provide a compelling case to elevate the role of CBOs in reform.
The authors, including HMA’s Ellen Breslin and Heidi Arthur, call for the development of a National Blueprint for Advancing Health Equity Through Community-Based Organizations to facilitate greater cross-sector collaboration between CBOs and HCOs.
Read the full brief here or on the AcademyHealth website.
Webinar Replay: Pathways HUB- A Population Health Model that Activates the Community Response to Social Determinants
This webinar was held on May 9, 2019.
One of the most successful approaches to addressing social determinants of health involves the coordination of community-based services and civic resources through a community hub funded by performance-based managed care payments.
This webinar will feature the co-developer of The Pathways Community HUB model, an approach designed to help coordinate outreach by specialized community health workers who are incentivized to engage high-need populations.
Speakers will also discuss how community hubs can be adapted to address broader community needs for an array of populations.
Learning Objectives
- Learn how to take local healthcare planning to the next level by identifying, activating, and financing community-based organizations through a community hub.
- Find out how the Pathways Community HUB can facilitate managed care payments for risk mitigation within attributed populations.
- Understand the value of coordinating with grassroots organizations and informal networks, such as faith-based groups, to better address social determinants of health.
- Find out how health systems can play a central role as the platform for community hubs, providing infrastructure, information technology, and administrative capabilities.
- Learn how to leverage the Pathways HUB toolkit to support the planning, development, and implementation of a community hub.
Speakers
- Heidi Arthur, Principal, HMA
- Mark Redding, MD, Co-Developer, Pathways Community HUB
Who Should Attend
Executives of health plans, providers, and community-based organizations; officials of state and local government, civic groups, grassroot organizations, faith-based groups, and community-based collectives.
HMA Conference to Feature Insights from 40+ Speakers, Including Health Plan CEOs, State Medicaid Directors, Providers
Pre-Conference Workshop: September 8, 2019
Conference: September 9-10, 2019
Location: Chicago Marriott Downtown Magnificent Mile
Health Management Associates is proud to announce its fourth annual conference on trends in publicly sponsored health care: The Next Wave of Medicaid Growth and Opportunity: How Payers, Providers, and States Are Positioning Themselves for Success.
The HMA conference has emerged as a premier informational and networking event, attracting more than 450 executives and policy experts. Speakers this year include state Medicaid directors and leaders from Medicaid managed care, hospitals, clinics, community-based organizations, and other providers.
CMS Announces Primary Cares Initiative
On April 22, 2019, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Primary Cares Initiative (PCI), which will present eligible providers and other entities with the opportunity to engage in value-based payment and direct contracting payment models for primary care beginning in January 2020. CMS designed PCI to reduce expenditures and preserve or enhance quality of care for beneficiaries in Medicare fee-for-service (FFS). PCI is comprised of two tracks, Primary Care First (PCF) and Direct Contracting (DC). The PCF track, which builds on the Comprehensive Primary Care Plus (CPC+) initiative, is intended for individual primary care practices and seeks to reward providers for reductions in hospital utilization and total cost of care through performance-based payment adjustments. Also, under the PCF track, practices that specialize in serving high-need and/or seriously ill populations will receive adjusted payments to account for the populations served. Providers that participate in these models will qualify as participating in an Advanced Alternative Payment Model and be eligible to receive full bonus payments under CMS’s Medicare Incentive Payment System (MIPS).
HMA Opioid Experts Are in Demand
As the national opioid epidemic continues, HMA experts are sharing their vast knowledge and experience related to substance use disorders (SUD) and addiction treatment systems with providers, policymakers and other stakeholders addressing this crisis.
Managing Principal Jonathon Blum Breaks Down Trump Administration’s Agenda for Pharmacy Rebates
Medicare policy expert and HMA Managing Principal Jonathan Blum weighed in on the Trump administration’s recently proposed rules for pharmacy rebates and plans to reduce prescription drug prices in a blog post for Health Affairs.
Blum provided insight to questions about implementation of the proposed drug rebate reforms and whether they will lead to lower drug prices. The fundamental changes proposed would govern how pharmaceutical manufacturers pay rebates to pharmacy benefit managers and managed care plans contracted with Medicare, as well as state Medicaid programs.
He also addressed the variables outlined in the administration’s 2018 plan, American Patients First, which aim to reduce out-of-pocket costs and lower drug prices.
Blum joined HMA in 2018. In his previous leadership role at the Centers for Medicare and Medicaid Services from 2009-2014 he had direct responsibility for administration of the Medicare program.
HMA colleagues conduct impact assessments of proposals developed by California future health workforce commission
A team of HMA colleagues, including Carrie Cochran, Helen DuPlessis, Kelly Krinn, Nora Leibowitz and Ryan Mooney, along with Healthforce Center at the University of California, San Francisco conducted impact assessments on recommendations developed by the California Future Health Workforce Commission.
The assessments were provided to the commission and used to help determine which of more than 30 proposals would be part of the commission’s final report. In addition, Nora Leibowitz summarized commissioner dissents with the draft recommendations and organized the outstanding issues for the report.
The final report, which identifies a doctor shortage in California and mechanisms for addressing the problems, included the supporting work by HMA.
Download the impact assessments below.
HMA MACPAC Report Published
A team of HMA colleagues including Sarah Barth, Sharon Silow-Carroll, Esther Reagan, Mary Russell and Taylor Simmons completed a study for the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) to examine care coordination requirements for several Medicare-Medicaid integrated care models.
The study’s final report, Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches, is posted to the MACPAC website.
The final report details state and federal managed care contract requirements for care coordination, summarizes stakeholders’ perspectives on care coordination based on structured interviews, and highlights promising care coordination practices and challenges for ensuring effective care coordination for dually eligible beneficiaries.