« The Dual Agenda: December 3, 2015 Issue

Noteworthy News

Community Catalyst and ACAP Release Report on Survey of Duals Demonstrations Plans

A new report released on Dec. 2 by Community Catalyst’s Voices for Better Health project and the Association for Community Affiliated Plans (ACAP) recommends 15 policy and operational changes that would yield significant improvements for Medicare-Medicaid beneficiaries enrolled in the Centers for Medicare and Medicaid’s  financial alignment demonstration underway in 13 states.

The recommendations are based on a survey conducted jointly by ACAP and Community Catalyst that queried 15 health plans participating in six of the states’ dual demonstrations—representing more than 100,000 members—and examined progress in three key areas for consumers and their families:  care coordination, self-direction for personal/home care services, and the role of Consumer Advisory Councils.

Survey data revealed challenges as well as plan innovations that are working well. Based on these findings, Community Catalyst and ACAP offer solutions to improve and strengthen care, services and ultimately the health of the dually eligible beneficiaries enrolled in the demonstrations. The authors identified 15 recommendations – six in the area of policy change and nine around operational changes plans can make – that are immediately actionable and can result in concrete improvements. 

Recommendations include:

• a more proactive approach by states and CMS in engaging primary care physicians, including additional reimbursement for their participation in care teams
• ensuring consistent ongoing contact between care coordinators and members
• providing enhanced training to plans and for consumers on the option to direct their own home care services, and
• offering training for members to enable effective participation on plan advisory committees

“This report offers policymakers and health plan leaders insights into the challenges of system change,” said Robert Restuccia, executive director of Community Catalyst, “and also concrete strategies and recommendations on how to improve care in the areas that are of top importance to enrollees.”

Community Catalyst Outlines Priorities for Health System Transformation

The Community Catalyst blog Health Policy Hub has begun a series outlining our policy priorities for Health System Transformation. Each blog will take a deep dive into one of the six areas we believe must be addressed to achieve better care, better value and better health. The first blog outlines our basic frame for addressing this complex set of topics, including the opportunities and risks, and highlights our six policy priorities. The second blog tackles the topic of payment reform, outlining the weaknesses of much of the current discussion on payment reform and highlighting how to move forward with an approach that embraces a true pro-consumer agenda. To sign up for Community Catalyst’s blog posts, please click here.

CMS Announces Significant Course Corrections for Dual Eligible Demonstrations

The Centers for Medicare and Medicaid Services (CMS) has announced that it intends to increase payments sooner than originally anticipated for health plans participating in one of the 12 capitated model dual eligible demonstration projects created under provisions of the Affordable Care Act. In late October CMS announced a set of proposed changes to the Medicare Advantage risk adjustment methodology. These changes are based on an evaluation of rates conducted by CMS and are designed to correct systemic underpayments to health plans that enroll large numbers of dually-eligible individuals. Community Catalyst has submitted comments in response to these proposed changes.  In mid-November CMS announced that it wants to move quickly to correct the problem and plans to increase rates for plans participating in the demonstration by 2016. In addition, CMS has announced that it wants to develop a separate star-rating system for plans participating in the demonstration. These plans have long argued that the rating system does not take into account the challenges of serving the dually eligible population.

Community Catalyst Submits Comments to CMS on Merit-Based Incentive Payments

Community Catalyst has submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to a Request for Information released regarding the implementation of the Merit-Based Incentive Payment System, Promotion of Alternative Payment Models and Incentive Payments for Participation in Eligible Alternative Payment Models. These new payment models emerged from the Medicare Access and Chip Reauthorization Act of 2015 (MACRA), which repealed the Medicare sustainable growth rate (SGR) formula and established these two payment tracks.

The comments highlight three significant areas: beneficiary engagement, disparities reduction, and fostering and incentivizing a culture of partnership and learning in the provider community. These comments are also applicable to Patient-Centered Medical Homes.

Community Catalyst Submits Comments to Health Care Payment Learning and Action Network

Community Catalyst has submitted comments to the Health Care Payment Learning and Action Network (LAN) on its white paper on Draft Alternative Payment Models (APM) Framework Principles. Community Catalyst’s comments respond to the overall approach described in the white paper, and then offer specific input on each of the five framework principles it contains. The comments place particular emphasis on three areas critical to consumers: beneficiary engagement, education and support; disparities reduction; and fostering and incentivizing a culture of partnership and learning.

Value of Service Coordinators Among Vulnerable Low-Income Seniors Quantified

A study by LeadingAge and the Lewin Group released Nov. 20 at the Gerontological Society of America’s annual meeting indicates that the availability of an on-site service coordinator, such as a social worker, at federally subsidized senior housing reduced hospital admissions among residents by 18percent. The study of over 8,000 seniors in 12 communities across the country focused on lower-income older adults, over half of whom were dually eligible for Medicare and Medicaid. Half of the seniors studied had five or more chronic conditions, such as heart disease, diabetes, arthritis or cancer.