Verma Addresses Medicaid Issues

Yesterday, Centers for Medicare & Medicaid Services administrator Seema Verma spoke at a conference of the National Association of Medicaid Directors.

In addition to discussing a proposed regulation posted earlier in the day that would introduce changes in the regulation of state financing of their Medicaid programs, Verma also addressed:

  • Medicaid demonstration programs
  • Medicaid work requirements
  • a shift toward value-based payments
  • better coordination of care for the dually eligible (individuals serve by both Medicaid and Medicare)
  • enrollment issues
  • improvements in the efficiency of the federal Medicaid bureaucracy

Because private safety-net hospitals care for so many more Medicaid patients than the typical hospital, these issues are especially important to them.

Read Verma’s complete remarks here.

Lessons in Serving Dual Eligibles

A new report examines the efforts of health plans to improve the delivery and coordination of care for dual eligibles: individuals covered by both Medicare and Medicaid.

This population has received growing attention from policy-makers, including the Centers for Medicare & Medicaid Services through its 2011 Financial Alignment Initiative that seeks to test new models of working with this difficult-to-serve population.

iStock_000008112453XSmallNow, the Center for Health Care Strategies has reviewed how 14 different health plans approached this challenge. It found that the plans generally:

  • supported individuals in the community by addressing housing and other social determinants of health and by reducing institutional care;
  • coordinated care delivery across providers and services;
  • identified unmet needs;
  • engaged providers across the continuum of care;
  • coordinated physical and behavioral health; and
  • explored alternative payment models.

The report also identified lessons learned based on the efforts of the 14 different approaches, including:

  • investing in relationships with states and providers was essential to success;
  • implementing extensive care management required significant time and resources; and
  • coordinating physical and behavioral health services required collaboration and information-sharing.

Because of where they are located, private safety-net hospitals generally serve far more dually eligible patients than the typical hospital.

To learn more about how the 14 different plans went about their work and what they learned along the way, go here to see the Center for Health Care Strategies report ACAP Medicare-Medicaid Plans and the Financial Alignment Demonstrations: Innovations and Lessons.


Low Participation Plagues Dual-Eligibles Demo

A federal demonstration program that seeks to improve care for those eligible for both Medicare and Medicaid is suffering from under-participation.

This perspective was presented during last week’s meeting of the Medicare Payment Advisory Commission, the independent federal agency that advises Congress on Medicare payment and policy issues.

Among the factors affecting participation have been difficulties identifying eligible participants, resistance from providers, and low provider payments.

iStock_000008112453XSmallBecause of the low participation, it has been difficult to measure the program’s effectiveness in better coordinating patients’ care.

Currently 61 health plans in 12 states participate in the program.

Such programs are important to priivate safety-net hospitals because those hospitals serve especially large numbers of low-income seniors.

Learn more about the program and the challenges it has faced in this McKnight’s Long-Term News article.

Dual Eligible Programs Show Mixed Results

The Affordable Care Act-inspired effort to find more effective ways to serve the so-called dual eligible population – mostly the disabled and low-income elderly covered by both Medicare and Medicaid – is not providing the kind of results policy-makers expected when they initiated new efforts to serve this high-cost population.

But not all of the news is bad.

iStock_000008112453XSmallOn one hand, enrollment figures for those eligible to participate have not met expectations, with some of those eligible afraid they might lose their providers and some of those providers persuading their patients not to participate. In addition, some health plans that participated in the earliest efforts have withdrawn in the face of declining enrollment.

On the other hand, employing care managers to serve members has shown signs of reducing hospitalizations and Medicare costs and individuals who do participate have expressed satisfaction with the service they are receiving.

Programs that serve dually eligible individuals are of special interest to private safety-net hospitals because the communities they serve typically have especially large numbers of such residents.

For a closer look at the effort’s expectations, where it has succeeded, and where it has encountered challenges, see this Wall Street Journal article.