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CMS Innovation Center’s Geographic Direct Contracting Model opportunity
This week, our In Focus section reviews a new model – Geographic Direct Contracting – introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries enrolled in the traditional fee-for-service program across an entire region. This model represents one of the most transformational models released by the Innovation Center. During the 6-year Geographic Direct Contracting model performance period the traditional Medicare program will be replaced by the Direct Contracting program in the 10 selected regions.
Commonwealth Fund blog highlights Medicare changes due to COVID-19
Jennifer Podulka penned a blog post for The Commonwealth Fund in conjunction with The SCAN Foundation, highlighting the legislative and regulatory changes made to Medicare in response to the COVID-19 pandemic. She was part of the HMA team who authored an Issue Brief and policy tracker earlier this year.
The future of quality reporting: understanding digital quality measurement practices
In the wake of the COVID-19 pandemic, the need for greater health information technology interoperability, “digital” measures of healthcare quality and performance, and advanced value-based care systems has grown. In January 2021, the National Committee for Quality Assurance (NCQA) publicly released its vision for healthcare quality measurement to the Biden-Harris Department of Health and Human Services (HHS) transition team. The paper, “The Future of Healthcare Quality,” focuses on four core areas, with three of them being specific to the evolution of a digital quality ecosystem:
Drivers and barriers to adopting flexible Medicare Advantage supplemental benefits
This week’s In Focus highlights a recent HMA publication examining the drivers and barriers to Medicare Advantage plan adoption of newly available supplemental benefits intended to address unmet health and social needs. Unlike Traditional Medicare, Medicare Advantage plans, which provide coverage for 40 percent of all Medicare beneficiaries, may offer enrollees supplemental benefits which are not covered by the Medicare program. Until recently, the Medicare program has required that supplemental benefits be limited to those that are medical in nature. However, in recent years, Congress and CMS —through four different legislative and regulatory authorities — granted new flexibilities for Medicare Advantage plans to offer non-medical benefits that address social needs. Medicare Advantage plans may also now tailor supplemental benefits and make them available only to certain subpopulations based on chronic disease or health status.
2021 Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access
The experts at Health Management Associates (HMA) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan’s decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
HMA further sought to understand the extent to which Medicare Advantage enrollees had access to these benefits when eligible, and the effectiveness of these benefits as a tool to contain costs, improve outcomes, and increase enrollee engagement and satisfaction.
The report outlines seven key insights and accompanying policy considerations aimed towards promoting evidence-based benefit designs; expanding Medicare Advantage organization willingness to adopt the flexible benefits; and enhancing beneficiary involvement, access, and usage of these benefits.
HMA colleagues Narda Ipakchi, Mary Hsieh, Sarah Barth, and Jonathan Blum contributed to the report which follows up on a previous report providing a snapshot of early adoption of these benefits.
This analysis was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.
Exploring Medicare Advantage supplemental benefits: HMA’s assessment of adoption, access, and policy opportunities
The experts at Health Management Associates (HMA) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan’s decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
Three HMA clinicians author naltrexone formulations in correctional settings issue brief
HMA’s Donna Strugar-Fritsch, Shannon Robinson, MD and Scott Haga, PA-C, recently authored the issue brief, Naltrexone Formulations in Correctional Settings. This brief provides clinical, financial, and administrative information prisons and jails can use in deciding whether to keep detainees on extended release naltrexone (XR-NTX, or the brand Vivitrol) or switch them to oral naltrexone tablets in instances where detainees have been prescribed XR-NXT prior to incarceration.
HMA expert provides Medicaid funding insights
HMA Managing Principal Anne Winter joined the “Our American States” podcast, produced by the National Conference of State Legislatures, to discuss emerging gene therapies and the high costs associated with them. The episode, The Fiscal Challenge of Emerging Gene Therapies, originally aired Jan. 11, 2021.