This week, we are providing an update on HMA’s inaugural conference on The Future of Publicly Sponsored Healthcare: Building Integrated Delivery Systems for Vulnerable Populations, October 10-12, 2016, at The Palmer House in Chicago. More than 200 industry leaders have already registered to attend, including top executives from hospitals, health systems, clinics, provider practices, community-based organizations, and Medicaid managed care plans. Featuring 37 high-level industry speakers, conference panels and breakout sessions are designed to inspire discussion about real-world approaches to helping provider organizations improve the health status of patient populations, lower costs, and ensure a more satisfactory patient experience. Visit the conference website at https://fpsh.healthmanagement.com/ for complete details.
1247 Results found.
Texas Submits Uncompensated Care Evaluation to CMS
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).
Report Evaluates Uncompensated Care and Medicaid Payments in Texas Hospitals
HMA was engaged by the Texas Health and Human Services Commission to perform an independent evaluation of Texas’ Uncompensated Care Pool, as required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, to submit to the Centers for Medicare and Medicaid Services (CMS). The report was submitted to CMS on August 31st.
Consistent with the approach it has taken in other states that operate uncompensated care pools, CMS required Texas to commission a detailed analysis of the state’s uncompensated care costs, payments and the impact of environmental factors and potential policy changes. Pursuant to the waiver Special Terms and Conditions (STCs), the report includes the following:
- A detailed description of the composition of current Medicaid hospital payments.
- Analysis of Medicaid financing and how the non-federal match is funded.
- Estimated cost incurred by hospitals to provide services to Medicaid beneficiaries compared to the cost to the corresponding payments received.
- Estimated cost of uncompensated care provided by hospitals and the portion of uncompensated care attributed to charity care.
- Analysis of the adequacy of Medicaid payments in relation to cost incurred by hospitals.
- Analysis of Texas Medicaid payment adequacy relative to other states.[1]
- Assessment of recent economic and environmental trends within Texas that may impact future reimbursement levels and the cost of caring for low-income populations.
- Estimated financial impact of: 1) implementing a Medicaid expansion for low-income adults; 2) Medicaid DSH reductions required by the Affordable Care Act (ACA); 3) reestablishing supplemental upper payment limit (UPL) payments; and 4) fully funding Medicaid hospital costs through payment rates.
[1] Note that this portion of the analysis and report were completed by Deloitte Consulting.
Illinois Releases Draft 1115 Waiver for Behavioral Health Redesign
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.
Prepare Now: New Codes for Integrating Primary Care and Behavioral Health
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 Tool Helps MCOs Implement Medicaid Managed Care Rules
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.
30-plus Speakers Slated for HMA Conference on Integrated Care Delivery
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.
HMA Authors Explore New Models of Care in Correctional Health
HMA Principals Donna Strugar-Fritsch and Linda Follenweider are featured authors in the spring edition of CorrectCare, the magazine of the National Commission on Correctional Health Care (NCCHC).
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.
MACRA: Will these carrots and sticks work?
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.
New Leadership, Team Building Workshop for Those Serving Vulnerable Populations
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.
Initiative to Decriminalize Mental Illness: Recommendations for a Treatment Center and Continuum of Care
The Baton Rouge Area Foundation (BRAF) tapped HMA to assess and recommend a comprehensive model of care for individuals in East Baton Rouge (EBR) Parish with behavioral health and substance use needs who, under the current system in place in EBR, may otherwise end up behind bars. HMA also took into account a model proposed by the Clinical Design Committee, which the BRAF convened.
The report, recently presented to BRAF, provides the following recommendations:
- Embrace a model of care that promotes a continuum-of-care strategy across the community and that focuses on targeted population health interventions—the provision of services that focus on outcomes for specific groups of people.
- Plan and implement a set of priority diversion processes and services, modeled after the diversion programs located in Bexar County, Texas, and tailored to meet the needs of the EBR community.
- Work toward a system of care that over time includes expansion of services anticipated to leverage the results of implementing the recommendations.
The report also lays out business plan and implementation components for the proposed crisis care and diversion center currently being called “the BRidge Center,” that are designed to address the challenges EBR is currently facing, with the goal of stopping the cycle of criminalization of people with behavioral health issues.
The report’s recommendations are based on an analysis of the current East Baton Rouge system of care that is available to support people with behavioral health issues, recommendations offered by over 35 EBR behavioral health and criminal justice leaders, and a review of national best practices and literature.
HMA Releases Medicaid Managed Care White Paper
Medicaid Managed Care is the subject of a recently released HMA white paper.
In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.
The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:
- Planning and implementation
- Stakeholder engagement
- Procurement approaches
- Outreach and enrollment
- Contract management and monitoring