This week, we reviewed the independent evaluation of Texas’ Uncompensated Care Pool submitted to the Centers for Medicare and Medicaid Services (CMS) by the Texas Health and Human Services Commission (HHSC). The evaluation, which was required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, was completed by Health Management Associates (HMA).
This week, we reviewed the draft Section 1115 Research and Demonstration waiver, released on August 26, 2016, by the Illinois Department of Healthcare and Family Services (DHFS). The 1115 waiver is proposed as part of the state’s broader initiatives around the State Innovation Model (SIM) design grant awards, the State Health Assessment (SHA), and the State Health Improvement Plan (SHIP), with goals of strengthening the state’s behavioral health care system, reducing silos in behavioral health care, and promoting greater integration of physical and behavioral health. The waiver specifically proposes the inclusion of a package of new benefits for individuals with severe mental illness (SMI) and substance use disorders (SUD), as well individuals nearing release from the Illinois Department of Corrections (IDOC) and Cook County Jail systems. DHFS estimates $1.2 billion in federal savings over the five-year waiver term, equaling a 2 percent spending reduction across all Medicaid spending compared to without-waiver spending estimates. DHFS is accepting comments on the draft 1115 waiver through September 26, 2016.
Integrating primary care and behavioral health is a central focus in health care delivery reform for many states and payers as they work towards addressing quality and cost containment. Significant research demonstrating the effect of co-morbid behavioral health conditions on overall health outcomes, and the subsequent cost increases, has led to exploring the implementation of new models of care.
HMA colleagues are often called upon to share their expertise in print and electronic publications. It’s also common for our colleagues to serve as presenters, providing insights about important topics of the day in webinars and at industry conferences. Recently three of our HMA consultants were featured as subject matter experts in prominent publications and events.
On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the final Medicaid managed care rules to modernize federal Medicaid managed care regulations. Many of the new rules go into effect July 2017. The hard work of implementing the new Medicaid managed care regulations will fall squarely on the shoulders of states and Medicaid managed care health plans. For managed care plans, they must step up their operational, administrative, and reporting capabilities to accommodate new state oversight requirements across all aspects of the contract performance.
HMA’s inaugural conference “The Future of Publicly Sponsored Healthcare: Building Integrated Delivery Systems for Vulnerable Populations” is slated for October 10-12 in Chicago. This premier event, presented by HMA and HMA’s Accountable Care Institute, will address key issues facing health systems, hospitals, clinics and provider practices seeking to integrate care in an environment of rising quality and cost expectations. More than 30 speakers have been confirmed to date. Early Bird registration is now open. Click here for complete conference details.
Based on a presentation at the NCCHC’s 2015 Leadership Institutes, “A Call for New Models of Care in Correctional Health” takes a look at components of new primary care models, how they’ve advanced care – and how they can be used in correctional settings.
The comment period for MACRA proposed rules started a couple of weeks ago and ends June 26, 2016. CMS is to be commended for valiantly translating MACRA legislation into specific rules that will apply at the start of the first performance period scheduled to be January 1, 2017 (wow!). However commendable though, we should all be clear about the inherent problems, of which there are a number. I’ll briefly outline one central problem: behavioral economics.
Transformation of healthcare delivery is requiring those of us who serve vulnerable populations to cultivate new leaders and form new kinds of teams inside and outside of our organizations.
HMA and Rush University Medical Center-Chicago are launching a new, one-day intensive workshop that will introduce proven strategies for developing a deep bench of collaborative leaders and empowered providers.
As many states continue to utilize all-payer claims databases (APCDs) to help improve the quality, cost and effectiveness of care, the U.S. Supreme Court’s recent decision in Gobeille v. Liberty Mutual Insurance Company will present some hurdles for states using (or thinking about using) APCDs moving forward.