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

New Tools for Addressing Old Medicaid Problems

The new federal Medicaid managed care regulation gives state Medicaid programs new tools with which to address longstanding Medicaid challenges.
In an article titled “The Medicaid Managed Care Rule: The Major Challenges States Face,” the Commonwealth Fund describes the tools the rule does and does not offer for addressing five major Medicaid challenges:

reaching medically underserved communities
unstable eligibility and enrollment
organizing coverage an care and developing effective payment incentives
aligning managed care with health, education, nutrition, and social services
information technology

Find the article here, on the Commonwealth Fund’s web site.

PA Safety Net Admin2016-05-10T06:00:30+00:00May 10th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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PA Safety Net Admin2016-05-10T03:48:21+00:00May 10th, 2016|Uncategorized|Comments Off

Background Information on Payment Methodologies and Benefit Design

The Urban Institute has issued two new papers with background information on health care payment methodologies and the design of health care benefits packages.
The first paper, Payment Methods: How They Work, describes nine payment methodologies:

fee schedules
primary care capitation
per diem payments to hospitals for inpatient visits
DRG-based payments to hospitals for inpatient visits
global budgeting for hospitals
bundled payments
global capitation for organizations
shared savings
pay for performance

The second paper, Benefit Designs: How They Work, explains seven different types of benefit designs:

value-based design
high-deductible health plans
tiered networks
narrow networks
reference pricing
centers of excellence
benefit design for alternative sites of care

A third paper, Matching Payment Methods with Benefit Designs to Support Delivery Reforms, describes how to match benefit designs with payment methods.
Go here to find Payment Methods: How They Work.
Go here to find Benefit Designs: How They Work.
And go here to find Matching Payment Methods with Benefit Designs to Support Delivery Reforms.

PA Safety Net Admin2016-05-09T06:00:00+00:00May 9th, 2016|Health care reform|Comments Off

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the April 2016 edition of Health Law News, its monthly newsletter.
phlp Included in this edition are articles about a new, faster process the state has introduced for people to enroll in Medicaid; the awarding of contracts to managed care organizations to participate in the state’s HealthChoices program; an update on the Community HealthChoices program that will help nursing home-eligible seniors remain independent in the community; new funding for the state’s “Money Follows the Person” demonstration program; and more.
Find the latest edition of Health Law News here.

PA Safety Net Admin2016-05-06T06:00:03+00:00May 6th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Awards HealthChoices Managed Care Contracts

Last week Pennsylvania’s Department of Human Services awarded new contracts to managed care organizations to provide physical health services under the state’s HealthChoices Medicaid managed care program.
Eight different organizations were awarded 23 separate three-year contracts, to take effect on January 1, 2017, to serve more than two million Medicaid beneficiaries in five state HealthChoices regions.
All of the managed care organizations will be operating under a contractual mandate to increase how much care they provide on a value-based purchasing basis through accountable care organizations, bundled payment models, patient-centered medical homes, and other integrated care delivery approaches. They also will be required to coordinate their efforts more effectively with the behavioral health care organizations that serve their members.
Learn more about who won the contracts and how the winners will be expected to perform differently than HealthChoices managed care organizations have in the past in this state news release.

PA Safety Net Admin2016-05-05T06:00:56+00:00May 5th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Uncategorized|Comments Off

PA Medicaid: One Year, 625,000 New Beneficiaries

Last week marked the one-year anniversary of Pennsylvania’s Affordable Care Act-authorized expansion of its Medicaid program.
In that year, nearly 625,000 Pennsylvanians enrolled in the program.
Among them,

46 percent are under the age of 35
109,000 are parents
300,000 are employed

pa healthchoices regions
If past Medicaid utilization patterns hold true, most of these new Medicaid beneficiaries will receive most of their health care benefits from the state’s private safety-net hospitals.
Learn more about Pennsylvania’s Medicaid expansion, who has taken advantage of it, and how the program has changed in the past three years in this state news release.

PA Safety Net Admin2016-05-04T06:00:05+00:00May 4th, 2016|Affordable Care Act, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Data-Sharing Could Help Address “High-Fliers”

A new study suggests that hospitals might better serve frequent emergency room patients if they share data with one another.
According to a new report in the journal JAMA Internal Medicine, nearly 70 percent of “high-fliers” – patients known to make repeated visits to hospital ERs – visited more than one hospital ER in a study of patients who had more than five ER visits in Maryland in 2014. As a result, individual hospitals may not have a complete picture of such patients’ medical issues and the frequency with which they are turning to hospitals for care – a problem that could detract from individual hospitals’ attempts to find better ways to serve such patients.
A possible solution, the study suggests, is better information-sharing among hospitals.
Pennsylvania’s safety-net hospitals serve more such patients than the typical hospital because their communities have more low-income and uninsured residents with limited access to medical care.
To learn more about the study and its implications for efforts to reduce overuse of hospital ERs, go here to find the JAMA Internal Medicine study “The Adequacy of Individual Hospital Data to Identify High Utilizers and Assess Community Health.”

PA Safety Net Admin2016-05-03T06:00:01+00:00May 3rd, 2016|Uncategorized|Comments Off

Medicare Proposes New Way to Pay Docs

Clinicians would be paid based more on the quality of care they provide than on the quantity of services they deliver under a new Medicare quality reporting and payment proposal released last week by the Centers for Medicare & Medicaid Services.
The proposal, required by Congress last year as part of the Medicare Access and CHIP Reauthorization Act that constituted the final “Medicare doc fix” and spelled the end of the sustainable growth rate formula that constrained Medicare payments to physicians for more than a decade, would be phased in over a period of years, would end so-called meaningful use requirements for physicians, and would compensate most clinicians based on their performance on quality measures, some of them of their own choosing, in four categories – quality, advancing care information, clinical practice management, and cost – that would be part of a new Merit-Based Incentive Payment System.
Clinicians who assume financial risk as part of what CMS is calling Advanced Alternative Payment Models – programs such as the Next Generation ACO model, the Comprehensive Primary Care Plus program, and tracks 2 and 3 of the Medicare Shared Savings Program – would participate in a separate quality reporting and payment program that would respond to the greater financial risks such providers shoulder with greater potential financial rewards.
Learn more about the latest Medicare proposal from the following resources:

a CMS fact sheet
a CMS video
an FAQ from Kaiser Health News
the 962-page proposed regulation itself

PA Safety Net Admin2016-05-02T06:00:53+00:00May 2nd, 2016|Medicare|Comments Off

CMS Unveils New Medicaid Managed Care Regulation

For the first time in more than 20 years, the federal government is introducing major changes in how it regulates Medicaid managed care.
The Centers for Medicare & Medicaid Services describes the 1425-page rule as aligning Medicaid managed care with other health insurance programs, updating how states purchase managed care services, and improving beneficiaries’ experience with Medicaid managed care.
To learn more about what CMS has proposed, go here to see the rule itself.
Go here to see CMS’s news release accompanying the new regulation.
Go here to (under the link “final rule”) to find nine fact sheets summarizing key aspects of the new regulation.
And go here for a commentary on the new rule and the context in which it was released by CMS acting administrator Andy Slavitt.
SNAP has prepared a memo describing the new rule. Representatives of such hospitals may request a copy of this memo by using the “contact us” link in the upper right-hand portion of this screen.

PA Safety Net Admin2016-04-28T06:00:55+00:00April 28th, 2016|Safety-Net Association of Pennsylvania|Comments Off

PHC4 Reports on Hip and Knee Replacement Surgery

phc4 The Pennsylvania Health Care Cost Containment Council has released a report on complications from hip and knee replacement procedures performed at Pennsylvania hospitals.
The analysis looks at more than 56,000 procedures performed in 2013, quantifying complications, lengthy hospital stays, readmissions, and more.
Find the PHC4 report here.

PA Safety Net Admin2016-04-21T09:35:49+00:00April 21st, 2016|Uncategorized|Comments Off

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