New Health Care Leaders Share Priorities

New leaders at the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation are quickly making their priorities known to health care industry stakeholders.

For new CMS administrator Chiquita Brooks-LaSure, her priority is coverage.  She has declared that “Our focus is going to be on making sure regulations and policies are going to be focused on improving coverage,” and while she hopes that states that have not yet expanded their Medicaid programs will take advantage of current federal incentives to do so, there is another path to coverage:  “…the public option or other coverage certainly would be a strategy to make sure people in those states have coverage.”

For new CMMI director Liz Fowler, one of her stated objectives is to make more value-based payment models mandatory rather than voluntary, noting that “What we have learned from CMMI models over the past 20 years is that voluntary models [are] subject to risk selection, which has a negative impact on the ability to generate system-level savings.”  To that end, Fowler said she and CMMI are exploring more mandatory models.

Learn more about the directions new federal health care leaders hope to take their operations in the Kaiser Health News article “Expanding Insurance Coverage is Top Priority for New Medicare-Medicaid Chief” and the Fierce Healthcare article “CMMI director:  expect more mandatory value-based care payment models.”

“Oh Say Can We See?”: Ways & Means Leaders Seek CMMI Transparency

The chairman and ranking member of the House Ways and Means Committee have written to CMS administrator Seema Verma to ask her to address the lack of transparency in the Center for Medicare and Medicaid Innovation.

In the bipartisan letter, committee chairman Richard Neal (D-MA) and ranking member Kevin Brady (R-TX) note that “…Congress established CMMI to test different innovative delivery system and payment models to improve quality and reduce costs for Medicare and Medicaid beneficiaries” but observe that “…significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the health care community.

Their request:

We strongly urge the Agency to provide more sunshine in this process, all allow Congress, beneficiaries, and stakeholders greater opportunity to provide feedback into the policies that CMMI tests that affect millions of Americans with Medicare.

The letter also poses a series of questions about CMMI’s current endeavors.

Learn more from the letter from Representatives Neal and Brady to CMS administrator Seema Verma.

Medicaid Birthing Model Improves Outcomes

A federal program to improve birth outcomes among Medicaid-covered women has produced positive results:  lower rates of pre-term births, fewer low birthweight babies, fewer C-sections, lower delivery costs, and lower first-year health care spending.

The “Strong Start for Mothers and Newborns” program was a four-year initiative established by the Affordable Care Act and developed by the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Innovation to employ patient education, nutrition, exercise, preparation for childbirth, breast-feeding, and family planning rather than strictly medical interventions and was delivered through three evidence-based prenatal care models:  Birth Centers, Group Prenatal Care, and Maternity Care Homes.

The program, operated in 219 separate sites in 32 states, served participants with especially challenging socio-economic risk factors:  unemployment, lack of a high school degree or GED, food insecurity, transportation challenges, chronic health problems, and previous poor birth outcomes.  The objective of the program was to find ways to overcome these social determinants of health and produce better birth outcomes and now, a new, independent evaluation has found that it did.

Learn more about Strong Start for Mothers and Newborns and what it has produced in the official program evaluation document.

Administration Moving Away From Value Pay?

First, new Medicare programs for lump-sums payments for cardiac care and joint replacements were scaled back.

Then, additional doctors were exempted from a new payment system that would have paid them more for the results they produce than for the quantity of care they provide.

Next, the Department of Health and Human Services presented a document outlining a new direction for its Center for Medicare and Medicaid Innovation.

And it announced that it was seeking input from doctors on payment policy.

All suggest that if the Trump administration is not moving away for paying for quality rather than quantity it is at least considering pursuing value in different ways.

What ways?  A recent article in the New York Times looked at these recent changes and presented the views of experts on where the administration may be going with Medicare payment policy.  Go here to see that article.

Group Seeks Preservation, Reform of Federal Innovation Effort

A coalition of 35 patient, physician, and hospital groups has written to new Secretary of Health and Human Services Tom Price and asked him to continue the federal government’s exploration of new ways to deliver and pay for Medicare services but to seek certain improvements in how those efforts are undertaken.

The coalition Healthcare Leaders for Accountable Innovation in Medicare asked Secretary Price for a reformed Center for Medicare and Medicaid Innovation so that it operates with

… appropriately-scaled, time-limited demonstration projects, greater transparency, improved data-sharing, and broader collaboration with the private sector.

The coalition also called for CMMI to operate under six guiding principles:

  • foster strong, scientifically valid testing prior to expansion
  • respect Congress’s role in making health policy changes
  • consistently provide transparency and meaningful stakeholder engagement
  • improve data sharing from CMMI testing
  • strengthen beneficiary safeguards
  • collaborate with the private sector

Read the coalition’s entire letter, including a list of the group’s members, here on the web site of the Healthcare Leadership Council.

Feds Launch Medicare-Medicaid ACO Model

The Center for Medicare and Medicaid Innovation has announced a new Medicare-Medicaid Accountable Care Organization Model that it says

…is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.

cmsIn this new model, the Innovation Center

… seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.

The Innovation Center envisions pursuing such undertakings with six states, which will be chosen on a competitive basis.

Learn more about the Medicare-Medicaid Accountable Care Organization model here, on the Innovation Center’s web site.

New ACO Model Targets Social Determinants of Health

The federal government is altering a previously announced accountable care organization model to help it target the social determinants of health of the patients it serves.

The Accountable Health Communities model, launched by the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation in January, has been modified to target “community-dwelling Medicare and Medicaid beneficiaries with unmet health-related social needs.”

According to a CMS fact sheet,

The foundation of the Accountable Health Communities Model is universal, comprehensive screening for health-related social needs of community-dwelling Medicare, Medicaid, and dual-eligible beneficiaries accessing health care at participating clinical delivery sites. The model aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

  • Housing instability and quality,
  • Food insecurity,
  • Utility needs,
  • Interpersonal violence, and
  • Transportation needs beyond medical transportation.

Addressing the health-related associated with social determinants of health has long been one of the major challenges private safety-net hospitals face.

iStock_000005787159XSmallCMS anticipated participating ACOs serving their members through annual screenings of needs, increased dissemination of information about how to address health-related social needs, and appropriate referrals to community resources to meet those needs.

Among the organizations invited to apply to participate are community-based groups, health care organizations, hospitals and health systems, institutions of higher education, and government entities. In recognition of the need for a more patient-focused approach than CMS proposed in January, the number of members participating ACOs must serve has been reduced the potential award amount has been raised.

To learn more about the Accountable Health Communities model, why it has been modified, what it hopes to accomplish, and how it will operate, see this CMS fact sheet.

CMS Demonstration to Tie Medical, Service Needs

A new federal demonstration program will attempt to help low-income Medicare and Medicaid recipients gain access to services that ultimately will improve their health.

The Accountable Health Communities project, developed by the Center for Medicare and Medicaid Innovation and launched by the Centers for Medicare & Medicaid Services (CMS), is a $157 million demonstration program that

… aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

  • housing instability and quality
  • food insecurity
  • utility needs
  • interpersonal violence
  • transportation needs beyond medical transportation

cmsThe federal government intends to provide grants of up to $4.5 million to as many of 44 projects that pursue better ways to identify selected patients’ non-medical needs and connect those patients with available services in their communities. The grant funding will pay for the programs, not the services themselves, and will be evaluated to determine their impact on the health of program participants and the health care services utilization of those participants in light of the program’s central objectives of testing whether addressing the targeted needs will improve participants’ health and reduce their health care utilization.

For further information about the Accountable Health Community project, see this Kaiser Health News report; this CMS news release; this CMS fact sheet; and “Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid,” a New England Journal of Medicine article that describes the program, its goals, and its underlying rationale.

Medicare Unveils New ACO Program

The federal Center for Medicare and Medicaid Innovation is launching a new accountable care organization (ACO) model through which providers can join together to serve Medicare patients.

The “Next Generation ACO” seeks to build on the experience, insight, and feedback gained through the Medicare Shared Savings Program and the Pioneer ACO model and give providers more tools for managing care and resources while also enabling them to take on more financial risk and earn greater financial rewards for doing so successfully.

A broader objective is to move Medicare closer to its stated goal of paying most providers based on the quality of care they deliver rather than on the quantity of services they provide.

The new model will have two risk tracks, one of which will be close to 100 percent risk, and a choice of four payment methodologies that will seek to facilitate a transition from fee-for-service to capitated reimbursement.  Those four payment systems are fee-for-service, fee-for-service with a monthly infrastructure payment, population-based payments, and capitated payments.

The Center for Medicare and Medicaid Innovation has created a number of resources through which interested parties can learn more about the new model:  a news release, a post on the blog of the Centers for Medicare & Medicaid Services (CMS), and a new web page devoted to the Next Generation ACO.

Parties interested in applying to become a Next Generation ACO must submit a letter of intent to the innovation center by May 1.

Innovation Center Introduces “Transforming Clinical Practices” Initiative

The federal Center for Medicare and Medicaid Innovation has launched a new, $840 million program designed to help clinicians achieve large-scale health transformation.

According to the agency’s news release, its “Transforming Clinical Practices” initiative

…will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated health care systems. These applicants could include group practices, health care systems, medical provider associations and others. This effort will help clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs.

Stock PhotoThe Center for Medicare and Medicaid Innovation was created as part of the Affordable Care Act and allocated $10 billion to spend on innovations in the delivery and financing of health care.  It expects to spend $840 million on this program over the next four years in increments of $2-50 million on “practice transformation networks” and “support and alignment networks.”  Hospitals, health systems, and large group practices are eligible to participate.

Letters of intent must be submitted by November 20 and the deadline for applications is January 6.

For further information about the program, see this news release announcing the initiative and go here for the program’s web site and additional program and application information.