PA Safety Net Admin, Author at Safety-Net Association of Pennsylvania

CMS Demonstration to Tie Medical, Service Needs

A new federal demonstration program will attempt to help low-income Medicare and Medicaid recipients gain access to services that ultimately will improve their health.
The Accountable Health Communities project, developed by the Center for Medicare and Medicaid Innovation and launched by the Centers for Medicare & Medicaid Services (CMS), is a $157 million demonstration program that
… aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

Housing instability and quality,
Food insecurity,
Utility needs,
Interpersonal violence, and
Transportation needs beyond medical transportation.

The federal government intends to provide grants of up to $4.5 million to as many of 44 projects that pursue better ways to identify selected patients’ non-medical needs and connect those patients with available services in their communities. The grant funding will pay for the programs, not the services themselves, and will be evaluated to determine their impact on the health of program participants and the health care services utilization of those participants in light of the program’s central objectives of testing whether addressing the targeted needs will improve participants’ health and reduce their health care utilization.
For further information about the Accountable Health Community project, see this Kaiser Health News report; this CMS news release; this CMS fact sheet; and “Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid,” a New England Journal of Medicine article that describes the program, its goals, and its underlying rationale.

PA Safety Net Admin2016-01-07T06:00:43+00:00January 7th, 2016|Uncategorized|Comments Off

DHS Secretary Describes Initiatives

In an op-ed piece in the Scranton Times-Tribune, Pennsylvania Department of Human Services Secretary Ted Dallas has outlined his organization’s major achievements of 2015 and its plans for 2016.
Among them are the state’s expansion of its Medicaid program and its plans to establish new contracts with HealthChoices managed care organizations that seek to shift the program’s emphasis from volume of care to value and outcomes through greater use of accountable care organizations (ACOs), bundled payments, patient-centered medical homes, and other value-based initiatives.
Find Secretary Dallas’s commentary here.

PA Safety Net Admin2016-01-04T11:40:53+00:00January 4th, 2016|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

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.
On 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 Pennsylvania 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.

PA Safety Net Admin2015-12-30T06:00:59+00:00December 30th, 2015|Medicare, Pennsylvania Medicaid policy|Comments Off

Latest Edition of Health Law News

The Pennsylvania Health Law Project has released the latest edition of its newsletter.
The December 2015 edition includes features about Community HealthChoices, the state’s proposed plan of mandatory long-term services and supports for selected Pennsylvanians; the extension of the state’s contract with its current enrollment broker for participation in the Office of Long-Term Living’s waiver programs; the expansion of a pilot program for pregnant women with substance abuse disorders; and more.
Find the newsletter here.

PA Safety Net Admin2015-12-28T06:00:32+00:00December 28th, 2015|Pennsylvania Medicaid policy|Comments Off

CHIP On the Move

Pennsylvania Governor Tom Wolf has signed a bill that shifts responsibility for Pennsylvania’s Children’s Health Insurance Program (CHIP) from the state’s Insurance Department to its Department of Human Services (DHS).
The move is designed to streamline the administration of the program and improve the delivery of services for the more than 150,000 children currently enrolled in CHIP.
DHS already administers the state’s Medicaid program, which serves more than 2.5 million Pennsylvanians.
Go here to see a state news release announcing the change.

PA Safety Net Admin2015-12-23T11:38:14+00:00December 23rd, 2015|Pennsylvania Medicaid policy|Comments Off

PHC4 Reports on Hospital Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued a report that offers a wide range of statistics describing the performance and quality of care provided by the state’s acute-care hospitals.
The report presents regional and hospital-by-hospital mortality and readmission rates for a wide variety of medical conditions, doing so on a regional basis.
It also tallies the volume of hospital patients according to medical conditions and describes who is paying for the different types of care hospitals are providing.
Go here to see the PHC4 report Hospital Performance Report: 2014 Data.

PA Safety Net Admin2015-12-18T06:00:37+00:00December 18th, 2015|Uncategorized|Comments Off

MedPAC Meets, Discusses Payment Issues

Last week the commissioners serving on the Medicare Payment Advisory Commission (MedPAC) met in Washington, D.C. to discuss the group’s future recommendations to Congress.

While MedPAC’s recommendations are not binding on Congress or the administration, they are highly respected and often find themselves worked into new law or regulations.
Among the issues MedPAC addressed during two days of public meetings were:

Medicare inpatient and outpatient payments
the Medicare Advantage program star rating system
payments to ambulatory surgery centers, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals
payments for physician services, home health services, hospice care, and outpatient dialysis

Find issue briefs on each subject, and copies of the presentations MedPAC staff made to commissioners, here on MedPAC’s web site.

PA Safety Net Admin2015-12-14T15:53:19+00:00December 14th, 2015|Medicare|Comments Off

Source Materials on Medicaid

The National Association of Medicaid Directors recently held its 2015 fall conference. The following are presentations made at the conference by state and federal Medicaid officials, consultants, foundation officials, associations, non-profit groups, and others.

PA Safety Net Admin2015-12-02T06:00:54+00:00December 2nd, 2015|Uncategorized|Comments Off

Little Outside Interest in HealthChoices

When Pennsylvania put its HealthChoices contracts up for bid, the sizeable market to be served – more than 2.5 million people – was expected to draw interest from major national managed care organizations that serve Medicaid patients.
It didn’t happen.
Instead, of the nine companies that submitted bids, only one came from a national company that did not already participate in HealthChoices: Centene, a St. Louis company that serves six million Medicaid patients in 21 states.
National Medicaid managed care organizations Anthem, Molina Healthcare, and WellCare did not bid.
Three much smaller organizations submitted bids to enter the Pennsylvania Medicaid market: Accendia, a subsidiary of Capital Blue Cross; Meridien Health Plan, a Detroit-based company serving 700,000 Medicaid recipients in six midwestern states; and Trusted Health Plan, a two-year-old plan currently serving Medicaid beneficiaries in Washington, D.C.
The state is expected to award contracts in its five HealthChoices zones in January.
Read more about the bidding for HealthChoices contracts in this Philadelphia Inquirer article.

PA Safety Net Admin2015-12-01T06:00:16+00:00December 1st, 2015|HealthChoices PA|Comments Off

Push From Volume to Value Continues

As the end of 2015 nears, CMS has used its blog to reflect on its continued efforts to move the U.S. health care system from one that pays for the volume of care provided to one that pays for the value of that care.
The blog notes the replacement of the sustainable growth rate (SGR formula) with a new payment system that better supports patient-centered care; the creation of the Home Health Value-Based Purchasing model; and the introduction of Medicare reimbursement for advance care planning.
The blog also describes the many programs launched by the Affordable Care Act-created Center for Medicare and Medicaid Innovation, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Comprehensive Care for Joint Replacement program, the Comprehensive Primary Care Initiative, the Independence at Home demonstration, the Bundled Payment for Care Improvement Initiative, and the State Innovation Models initiative.
Together, CMS hopes these and other programs will help achieve its stated goal of paying for 30 percent of Medicare services through alternative payment models and making 85 percent of payments based on quality or value by the end of 2016.
For a better sense of how CMS sees these efforts pushing toward its policy objectives, see the commentary “Continuing the shift from volume to results in American healthcare” here, on the CMS blog.

PA Safety Net Admin2015-11-30T06:00:46+00:00November 30th, 2015|Affordable Care Act, Health care reform, Medicare|Comments Off

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