« The Dual Agenda: December 3, 2015 Issue

State Highlights

California

The California Department of Healthcare Services (DHCS) posted the November enrollment report for the Cal MediConnect program. DHCS has also posted a draft Cal MediConnect Beneficiary Toolkit for stakeholder comment. The toolkit provides a comprehensive overview of the program and is intended to help beneficiaries better understand the Cal MedicConnect program.

In other news, as skyrocketing drug prices continue to attract media and political attention, California is taking some aggressive actions to control costs. These efforts began earlier this year after Covered California, the state's health insurance exchange marketplace established under the Affordable Care Act, became the first in the nation to apply a cap to outpatient prescription drug costs to treat certain life-threatening conditions. The cap limits co-payments to $250 per drug per month. Then, a few weeks ago Governor Jerry Brown signed into law Assembly Bill 339, which mimics the exchange's prescription drug co-payment cap and covers those who get their insurance outside the exchange. The caps go into effect on Jan. 1, 2016 for those in Covered California. On Jan. 1, 2017 AB 339 kicks in for those buying private insurance plans independently and those covered through their employer’s plan.

Maryland

A Health Affairs blog post offers the perspective of two Johns Hopkins Hospital physicians on Maryland’s groundbreaking experiment with global hospital payments. The article provides a good summary of the Maryland program and also raises concerns, including a potential clash of financial incentives between hospitals and doctors, system-gaming and payment for out-of-state patients, and problems with quality measurement. The authors note that transforming care will require not just changes in payment, but changes in the culture of medicine.

Massachusetts

MassHealth, the state’s Medicaid program, has posted the November enrollment report for the One Care dual eligible demonstration project.

New York

The Center for Health Care Strategies (CHCS) has released a report – Navigating the New York State Value-Based Payment Roadmap – that outlines New York’s ambitious plans to transform how it pays for health care. New York is currently implementing a large Delivery System Reform Incentive Payment (DSRIP) program, as well as a State Innovation Model (SIM) initiative. The state is also one of those participating in the dual eligible demonstrations. The CHCS report describes New York’s value-based payment goals and describes the state’s approach to working with providers to shift to new payment models.

In September the NY State Department of Health (NYDOH) issued revisions to its Interdisciplinary Care Team (IDT) policy for the Fully Integrated Duals Advantage (FIDA), the state’s dual eligibledemonstration project. These revisions included several suggestions made by advocates, including allowing a specialist to lead the IDT when the primary care physician refuses and insuring ADA and Olmstead protections.  NYDOH has also developed a fact sheet that outlines the benefits available to beneficiaries participating in the dual eligible demonstrations.

Ohio

An article in The Columbus Dispatch highlights the high costs of health insurance and the lack of affordability for many low-income Ohioans. Cathy Levine, Executive Director of UHCAN Ohio, is quoted in the article about high costs and suggests that the focus of the health care system should be on prevention and managing chronic conditions. “This is of particular concern for people who have chronic conditions who need more than an annual wellness exam,” Levine states. Ohio’s Office of Health Transformation (OHT) has set a goal of having  80 percent of Ohioans receive their care through a value-based payment model within a few years. The hope is that a value-based system  can better manage chronic conditions to help patients avoid emergency room visits and hospitalizations. MyCare Ohio and Patient Centered Medical Homes are just one of the models that OHT is pursuing to improve care for the most vulnerable Ohioans.

Pennsylvania

Community Catalyst partners at Pennsylvania Health Access Network (PHAN) have been working with two Pennsylvania housing groups, Project Home and Pennsylvania Health Law Project, to pursue an integrated care model that will use Medicaid dollars for supportive housing services. This work has been made possible by PHAN’sValue Advocacy Project grant. Now the federal government is launching a joint initiative between the U.S. Department of Housing and Urban Department (HUD), Health and Human Services (HHS), and The U.S. Interagency Council on Homelessness (USICH) for states needing targeted program support aimed at strengthening state-level collaboration between health and housing agencies. PHAN and its partners are poised to take advantage of this opportunity because of their coalition work through the Value Advocacy Project.

Vermont

Vermont’s Office of the Health Care Advocate released a policy paper entitled Consumer Principles for Vermont’s All-Payer Model. The paper outlines consumer-oriented priorities and concerns related to payment reform in Vermont. Those principles are:

• Access to Care: The all-payer model must improve access to care for Vermonters
• Quality of Care: The all-payer model must improve health care quality
• Consumer Protection: Consumer protections must be put in place to ensure that the all payer model improves access to and quality of care for all Vermonters
• Consumer and Patient Engagement: The state, the ACO and individual providers must engage patients and consumers as the all-payer model is implemented
• Transparency: Planning, implementation and governance of the all-payer model and single ACO must be transparent and include input from stakeholders and the public
• Social Determinants of Health: Concrete steps must be taken to address social determinants of health under the all-payer model
• Integration: Under the all-payer model, there must be integration and coordination across the full continuum of care

Washington

The National Academy for State Health Policy (NASHP) has posted a blog that describes the state of Washington’s Accountable Communities for Health (ACH) initiative. Nine regional ACHs, governed by public-private partnerships, will bring together health care providers, social service organizations and others to improve health, health systems, population health, and to drive physical and behavioral health integration. ACHs are being phased in throughout Washington based on community readiness.