« The Dual Agenda: January 14, 2016 Issue

Noteworthy News

Enrollment Numbers for Dual Eligible Demonstration Projects

Total enrollment in the nine states currently implementing capitated model financial alignment demonstrations for dually eligible beneficiaries decreased slightly, from 378,640 in November to 371,358 in December. Those states are California, Illinois, Massachusetts, Michigan, New York, Ohio, South Carolina, Texas and Virginia. For a breakdown by state and health plan, see the enrollment chart here.

Community Catalyst Submits Comments on CMS  Proposals

Community Catalyst submitted comments on two important proposals from the Centers for Medicare and Medicaid Services (CMS).  In late December, comments were submitted on the Medicare-Medicaid Plan (MMP) Quality Ratings Strategy. Community Catalyst particularly highlighted three areas of concern:

• Community integration/long-term services and supports
• Management of chronic conditions/health outcomes
• Member experiences with health plans and care providers

In early January, Community Catalyst submitted comments to CMS on proposed rules regarding discharge planning.  In its comments, Community Catalyst applauds CMS for its efforts to improve discharge planning and makes additional recommendations for the safe transfer of Medicare and Medicaid beneficiaries from one setting to another.

CMMI Announces Funding to Connect Medical Care with Social Services           

The Center for Medicare and Medicaid Innovation (CMMI) has announced a major new initiative that will seek to address the social and economic determinants of health. Factors like stable housing, access to healthy food, reliable transportation and safe neighborhoods often have a more significant impact on people’s health than access to health care. Accordingly, CMS has announced the development of a new $157 million “Accountable Health Communities” program in which grantees will try to demonstrate better ways to connect patients with non-medical social services that will improve their health. The project will fund up to 44 separate projects over five years, and winning proposals will be announced later this year.

Study Puts the Focus on Price in Controlling Health Care Spending

A new study released in mid-December zeros in on high prices as the cause of excessive health care spending for privately insured consumers. While past studies have focused just on Medicare spending, the new work relies on a large newly-public database drawn from private insurance plans. The results show that localities that spend less on Medicare do not necessarily spend less on health care overall. Indeed, some areas with low Medicare spending show very high spending for consumers with private insurance. Atul Gawande, who first reported on wide variations in Medicare spending in 2009, responded to the new study in an article in The New Yorker. Dr. Gawande observes that wide regional variations in pricing for Medicare patients seems to be caused by high volume of tests and treatments, whereas high prices are the prime cost driver for consumers with private insurance.  This new study seems sure to increase the focus on price as advocates and policymakers continue to grapple with rising health care spending.

CMS Announces New Participants in Medicare ACOs

The Centers for Medicare & Medicaid Services (CMS) announced 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve the care patients receive in the health care system and lower costs. CMS also announced that providers and hospitals have signed up to join new types of ACOs, where they are paid for positive patient outcomes as well as will receive penalties for negative ones. With new participants in the Shared Savings Program (SSP), the Next Generation ACO Model, Pioneer ACO Model, and the Comprehensive ESRD Care Model, there will now be nearly 8.9 million beneficiaries served in variety of ACO models.

Health Care Payment Learning and Action Network Releases Final Alternative Payment Model White Paper

The Health Care Payment Learning and Action Network (HCP-LAN) released its final Alternative Payment Model (APM) Framework White Paper this week. The APM Framework defines payment model categories and will be used to benchmark efforts to increase the adoption of APMs across the U.S. health system. Community Catalyst did submitted comments to the draft white paper in November.