This week, our In Focus reviews a case study called, “Spotlight on Health Center Payment Reform: Washington State’s FQHC Alternative Payment Methodology,” authored and prepared for the National Association of Community Health Centers by Health Management Associates’ Principal Art Jones and Senior Consultant Liz Arjun. The study, published in May 2018, looks at Washington’s fourth federally qualified health center (FQHC) Alternative Payment Model (APM4), implemented in July 2017.
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 28 states. Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. Nearly all 28 states highlighted in this review have released monthly Medicaid managed care enrollment data into the second quarter (Q2) of 2018. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
This week, our In Focus Focus reviews the Mississippi Children’s Health Insurance Program (CHIP) request for qualifications (RFQ) issued by the state’s Division of Medicaid on June 8, 2018. The Mississippi CHIP program provides statewide health coverage in all 82 counties to children in families with incomes up to 209 percent of the federal poverty level (FPL). As of March 2018, 46,958 children were enrolled in CHIP.
This week, our In Focus comes from Senior Consultant Rachel Patterson, who provides an overview of Chapter 3 of the Medicaid and CHIP Payment and Access Commission (MACPAC) June 2018 Report to Congress on Medicaid and CHIP, which examines the growing role of managed care in long-term services and supports (LTSS). Chapter 3 includes research conducted by teams including HMA Principals Sarah Barth and Karen Brodsky regarding network adequacy for home and community-based service (HCBS) and Principals Sarah Barth, and Sharon Lewis and Senior Consultant Rachel Patterson regarding enrollment of people with intellectual and developmental disabilities (ID/DD) into MLTSS.
This week, our In Focus section comes from Ellen Breslin in our Boston office who provides an overview of MassHealth’s Duals Demonstration 2.0 (“Duals Demo 2.0”) proposal to the Centers for Medicare and Medicaid Services (CMS) which is designed to “grow and sustain One Care and Senior Care Options (SCO) while encouraging innovation and care delivery improvement.” MassHealth currently provides coverage to about 310,000 dually-eligible individuals. Combined, MassHealth and Medicare spend more than $9 billion annually with costs nearly evenly split across the two payers.
This week, our In Focus section highlights HMA Medicaid Market Solutions (MMS) which is supporting state flexibility in designing and implementing initiatives, including Section 1115 Demonstration Waivers, promoting member engagement, and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing an in-depth look at the facets of these new Medicaid models.
HMA Conference on the Rapidly Changing World of Medicaid to Feature Insights from 30-Plus Speakers, Including Health Plan CEOs, State Medicaid Directors, Providers
Pre-Conference Workshop: Sept. 30
Conference: Oct. 1-2
Location: The Palmer House, Chicago
Health Management Associates is proud to announce its third annual conference on trends in publicly sponsored health care: The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States.
In April, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2019 Final Rate Announcement and Call Letter for Medicare Advantage (MA) and Part D. The guidance was very good for the industry, with a projected average increase in revenue of 3.4 percent.
The Final Call Letter also included important new flexibilities that will help plans bring more innovative products to market and deliver more comprehensive care to enrollees. As early as next year, plans can offer supplemental benefits under an expanded definition of “primarily health related.”
This week, our In Focus section reviews the North Carolina Department of Health and Human Services (DHHS) Medicaid Managed Care Proposed Policy Paper released on May 16, 2018, Prepaid Health Plans in North Carolina Medicaid Managed Care, ahead of a competitive procurement for the new Medicaid managed care program expected to be released in spring or summer 2018. North Carolina will be contracting with statewide Medicaid managed care organizations (Commercial Plans, CPs) as well as regional provider-led managed care entities (Provider-Led Entities, PLEs) to serve 1.9 million Medicaid beneficiaries beginning in 2019. All plans are considered by the state to be Prepaid Health Plans (PHPs). The policy paper provides additional detail on the characteristics and requirements that apply to CPs and PLEs. To read HMA’s previous analysis of “North Carolina’s Proposed Program Design for Medicaid Managed Care,” click here.
This week, our In Focus, written by HMA Principal Anne Winter and Senior Consultant Aimee Lashbrook, examines American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, released May 11, 2018. Over time, the pharmaceutical supply chain has become a complex ecosystem, responding to the ever-changing dynamics of new drug products, pricing strategies, health care reform, benefit design, and the regulatory environment making it, arguably, the most complicated in health care. Due to this complexity, solutions to equitably control drug pricing will take a multiprong approach that includes regulatory redesign.