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

Looking at Payment and Delivery System Reform

Last fall the Robert Wood Johnson Foundation brought together grant recipients and national experts to talk about health care payment and delivery system reform design and implementation issues.
Now, the foundation has released a brief paper that addresses what the experts consider to be the three greatest challenges in the pursuit of such reform:

Aligning alternative payments with clinician compensation
Considering social determinants of health in payment reform models
Repurposing hospital resources

The paper also takes a look at whether health care payments should be subject to risk adjustment to reflect the social and economic barriers to better health and care that some patients face. This is an important issue for Pennsylvania’s safety-net hospitals because of the significant numbers of low-income patients they serve.
These issues and more are addressed in greater detail in the new paper “Three Emerging Challenges for Sustained Payment and Delivery System Reform,” which can be found here.

PA Safety Net Admin2015-04-14T06:00:13+00:00April 14th, 2015|Uncategorized|Comments Off

Medicare-Medicaid Coordination Office Reports to Congress

The federal agency created by the Affordable Care Act to facilitate better coordination of federal benefits for those eligible for both Medicare and Medicaid has issued its annual report on its activities to Congress along with a number of recommendations for future policy changes.
In addition to reporting on its work over the past year, the Medicare-Medicaid Coordination Office recommended that Congress consider legislation to:

Create a pilot to expand the PACE program (Programs of All-Inclusive Care for the Elderly) to people between the ages of 21 and 55.
Ensure retroactive Medicare Part D coverage for newly eligible low-income beneficiaries.
Establish an integrated appeals process for dually eligible (Medicare and Medicaid) enrollees.
Allow for federal/state coordinated review of duals special need plan marketing materials.

The report also identified three areas the agency intends to explore further in the coming year:

Coverage standards for overlapping Medicare and Medicaid benefits.
Cost-sharing rules for qualified Medicare beneficiaries.
Quality measures and Medicare-Medicaid enrollees.

Because they serve so many low-income, dually eligible patients, Pennsylvania’s safety-net hospitals often have a considerable stake in this office’s efforts.
Find the Medicare-Medicaid Coordination Office’s complete report to Congress here.

PA Safety Net Admin2015-04-10T06:00:12+00:00April 10th, 2015|Uncategorized|Comments Off

MACPAC Looks at Value-Based Purchasing in Medicaid

At a recent meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC), the agency’s staff made a presentation on how different states are pursuing value-based purchasing in their Medicaid programs.
The presentation focused on current efforts in three states: Connecticut, Maryland, and Oklahoma, describing the policy approach those states have taken, the models they employ, the implementation challenges they have faced, and how they evaluate the effectiveness of their efforts.
Because they care for so many Medicaid patients, Pennsylvania’s safety-net hospitals have a special interest in new approaches to paying for Medicaid services.
Find the MACPAC presentation here.

PA Safety Net Admin2015-04-09T06:00:12+00:00April 9th, 2015|Pennsylvania safety-net hospitals|Comments Off

MACPAC Looks at DSRIP

The legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and state governments on Medicaid and Children’s Health Insurance Program (CHIP) issues recently took a look at a relatively new type of supplemental Medicaid funding.
The Medicaid and CHIP Payment and Access Commission (MACPAC) is examining Delivery System Reform Incentive Payment Programs (DSRIP), which it describes as

a new type of supplemental payment that provide incentive payments for hospitals and other providers to undertake delivery system transformation efforts. Currently operating in California, Texas, Massachusetts, Kansas, New Jersey, and New York, DSRIP projects are led by hospitals, but often involve collaborations with non-hospital providers. They generally fall into two categories—infrastructure development and care innovation and redesign. Payments are tied to corresponding improvements in health outcomes for Medicaid enrollees and the uninsured.

MACPAC’s staff delivered a presentation on DSRIP to commission members. See that presentation here.

PA Safety Net Admin2015-04-08T06:00:53+00:00April 8th, 2015|Uncategorized|Comments Off

How States View Medicaid Reform

What are states looking for from “Medicaid reform”?
How do they evaluate the prospects of reform proposals – and how do they evaluate reforms that have been implemented?
Across the country, states are pursuing Medicaid reform through section 1115 waivers, Delivery System Reform Incentive Payment Programs (DSRIP), the State Innovation Models (SIM) Initiative, and other means. As they do, they must decide what innovations to pursue and then make decisions about whether those they have chosen have achieved their objectives and produced genuine payment and delivery system reform, improved outcomes, and laid a foundation for further improvement.
Many of these decisions are made by state Medicaid directors, and now, the National Association of Medicaid Directors has published a paper offering its perspective on Medicaid reform: what it is, what it looks like, and how they will approach it. See its paper Perspectives on Innovation here.

PA Safety Net Admin2015-04-03T06:00:35+00:00April 3rd, 2015|Pennsylvania Medicaid policy|Comments Off

GAO Reports on CHIP Extension

As a House-approved bill that would extend authorization for the Children’s Health Insurance Program (CHIP) for two years awaits Senate consideration, the U.S. Government Accountability Office (GAO) has issued a mandated evaluation of the program.
Among the GAO’s findings, it concluded that children enrolled in the program

… (1) had substantially better access to care, service use, and preventive care when compared with uninsured children; and (2) experienced comparable access and service use when compared with privately insured children.

It also found that nearly all children between the age of one and two enrolled in CHIP or Medicaid made at least one visit to a primary care physician in 2013; that the program’s costs for families were almost always less than states’ benchmark plans established under the Affordable Care Act; and that its benefits were generally comparable to those offered by benchmark plans.
For a closer look at the GAO report Children’s Health Insurance Program: Effects on Coverage and Access, and Considerations for Extending Fund, find links to a summary and the full report here, on the GAO web site.

PA Safety Net Admin2015-04-02T06:00:52+00:00April 2nd, 2015|Uncategorized|Comments Off

State Uses DSRIP Innovation Funding to Improve Care for Urban Poor

New York Medicaid program is taking advantage of federal innovation money to explore new approaches to serving low-income urban Medicaid patients.
With the help of Delivery System Reform Incentive Payments (DSRIP), special Medicaid funding from the federal government, caregivers serving Medicaid patients are organizing into accountable care organizations (ACOs) in New York City.
Under the experiment, doctors and hospitals join together to serve populations of Medicaid patients. While the doctors are currently paid on a fee-for-service basis, the program’s goal is to move them toward outcomes-based reimbursement, with bonuses paid to providers who achieve specific goals for improving the health of their patients.
The state plans to spend $1 billion over the next five years on this aspect of its innovation program.
Learn more about how New York seeks to use DSRIP funding to improve the delivery of care to its Medicaid population in this New York Times report.

PA Safety Net Admin2015-04-01T12:00:51+00:00April 1st, 2015|Uncategorized|Comments Off

Providers Can’t Sue Over Low Medicaid Payments

Health care providers may not turn to the courts when they believe their state Medicaid program is not paying them enough for the services they deliver, the Supreme Court has decided.
Instead, they must seek help from the federal government, which makes the rules that govern Medicaid provider payments.
The Supreme Court decision overturns a lower court ruling in response to a suit by facilities in Idaho that provide residential services to the disabled claiming that the state was paying them less than it had agreed to pay. As a result, providers must now turn to the Centers for Medicare & Medicaid Services (CMS) if they believe they are not being paid fairly.
Learn more about the Supreme Court’s decision in this news story in The Hill.

PA Safety Net Admin2015-04-01T06:00:50+00:00April 1st, 2015|Uncategorized|Comments Off

340B Program Faces Challenges, Change

A federal program that helps selected health care providers obtain discounted drugs for low-income patients they are serving on an outpatient basis may soon face major changes.
The 340B prescription drug pricing program, created more than 20 years ago to help serve low-income individuals, has come under fire in recent years in both the House and the Senate over how qualified, participating providers – disproportionate share hospitals, Federally Qualified Health Centers and their look-alikes, children’s hospitals, critical access hospitals, rural referral centers, and others – use the savings they derive from the program. While there is a general expectation that providers will use those savings to provide additional services to low-income patients, they are required neither to do that nor to discloses how they do use their savings.
The House Energy and Commerce Committee held a hearing about the program last week and Congress has asked the Medicare Payment Advisory Commission (MedPAC) to look into the program as well.
In addition, the U.S. Government Accountability Office (GAO) recently published an update on the status of its 2011 recommendations for improving the program, which it found suffered from inadequate oversight by Health Resources and Services Administration (HRSA), lacked adequate criteria for determining patient and provider eligibility, and lacked controls for preventing drugs acquired through the program from being diverted to ineligible patients.
The administration has long been thought to be preparing new guidelines for the 340B program.
Most Pennsylvania safety-net hospitals qualify for the 340B program because of the many low-income patients they serve, so any changes in the program will be of special interest to them.
For a closer look at the issues surrounding the 340B program, see this Roll Call blog report. Find a summary of the GAO report Drug Discount Program: Status of GAO Recommendations to Improve 340B Drug Pricing Program Oversight and a link to the study itself here and a report on some of the testimony provided at the congressional hearing here.

PA Safety Net Admin2015-03-30T06:00:39+00:00March 30th, 2015|Pennsylvania safety-net hospitals|Comments Off

PA Medicaid Transition Timetable

The Pennsylvania Department of Human Services has published a “HealthChoices Key Events and Milestones” table outlining the key steps in the state’s transition from the Healthy PA Medicaid expansion to the Wolf administration’s Medicaid expansion through the state’s existing HealthChoices program.
Listed on the timetable are the major steps in that transition and target dates for the completion of each.
Find that timetable here.

PA Safety Net Admin2015-03-27T06:00:46+00:00March 27th, 2015|Uncategorized|Comments Off

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