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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.
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.”
PHC4 Reports on Hip and Knee Replacement Surgery
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.
Could Housing Support Help Medicaid Behavioral Health Patients?
Amid indications that assisting with permanent supportive housing can be a cost-effective, evidence-based way of helping to address the behavioral health needs of some Medicaid recipients, housing and behavioral health groups are beginning to take a closer look at how Medicaid resources might be used to help support such housing.
In a new report, the National Council for Behavioral Health examines the possibility of using Medicaid resources to finance the delivery of services in supportive housing for Medicaid beneficiaries facing behavioral health challenges.
The report examines the policy context for developing integrated permanent supportive housing options in state Medicaid programs; opportunities for Medicaid to finance and deliver housing-related services; and the implications for behavioral health authorities and providers.
For a closer look at the issue, its implications, and the means through which such resources might be brought to bear, go here to see the National Council for Behavioral Health report Using Medicaid to Finance and Deliver Services in Supportive Housing: Challenges and Opportunities for Community Behavioral Health Organizations and Behavioral Health Authorities.
Academy Offers Practices to Improve Care for Disadvantaged Patients
The National Academies of Science, Engineering, and Medicine has published a new report that acknowledges the challenges faced by hospitals that care for socio-economically challenged patients and offers suggestions for how to serve those patients more effectively.
The report, Systems Practices for the Care of Socially At-Risk Populations, is the second in a projected series of five reports on the subject.
The study notes that
Emerging evidence suggests that providers disproportionately serving patients with social risk factors for poor health outcomes may be more likely to fare poorly on quality rankings and to receive financial penalties, and less likely to receive financial rewards.
Because the study did not include any original empirical research and is based instead on literature reviews and case studies, the Academy declined to suggest best practices for serving this challenging population but did offer six recommendations for improving care to socio-economically disadvantaged communities:
- Commitment to health equity. Value and promote health equity and hold yourself accountable.
- Data and measurement. Understand your population’s health, risk factors, and patterns of care.
- Comprehensive needs assessment. Identify, anticipate, and respond to clinical and social needs.
- Collaborative partnerships. Collaborate within and across provider teams and service sectors to deliver care.
- Care continuity. Plan care and transitions in care to prepare for patients’ changing clinical and social needs.
- Engaging patients in their care. Design individualized care to promote the health of individuals in the community setting.
The study also acknowledged the importance of adequate provider (primarily Medicare) payments in serving such a challenging population:
Both the availability of resources and alignment of financial incentives are prerequisites for the adoption and sustainability of these practices…Resources can provide the incentives to reduce disparities by targeting interventions at socially at-risk populations and incorporating equitable care and outcomes into accountability processes. Interventions that improve health and quality of care or reduce utilization and cost are only sustainable if the provider’s profits are higher with the intervention than without. Most of the efforts presented by the committee involve fixed costs and potentially shared benefits across multiple payers, so their economic feasibility depends on Medicare’s payment system and that of other payers. Environments in which a greater share of a provider’s revenue derives from payments related to health outcomes will make it more sustainable for them to invest in programs that improve quality and reduce cost.
The communities described in the report are the very types of communities Pennsylvania’s safety-net hospitals serve.
To learn more about what the Academy learned and what it has recommended, go here to see its news release accompanying publication of the report and go here to see the report itself.
Beware Medicaid Block Grants, Analysis Suggests
When the federal government turns housing, health, and social services programs into block grants, funding for such programs erodes over time, according to a new analysis by the Center on Budget and Policy Priorities.
The study found that
Policymakers advancing these proposals often accompany them… with assurances that the new block grant would get the same overall amount of funding as currently goes to the individual programs that it would replace. This new analysis of several decades of budget data strongly suggests, however, that even if a new block grant’s funding in its initial year matched the prior funding for the programs merged into the block grant, the initial level likely wouldn’t be sustained. History shows that when social programs are merged into (or created as) broad block grants, funding typically contracts — often sharply — in subsequent years and decades, with the reductions growing over time.
Of 13 such transitions from appropriation to block grant status in recent years, 11 of the programs shrunk in inflation-adjusted terms, some of them significantly so, with a median decline for the 13 of 26 percent to date.
The analysis also found that
The marked deterioration in block-grant funding over time controverts the common claim by block grant proponents that if funding levels prove inadequate, Congress will step in to provide appropriate additional funding. The general lack of responsiveness of block-grant funding to changes in need contrasts sharply with the high degree of responsiveness of entitlement programs such as SNAP (formerly known as the Food Stamp Program).Â
The study comes at a time when some policy-makers are talking about converting Medicaid into a block grant program. This proposal has been around for years and periodically resurfaces, as it has in the past year.
For a closer look at what happens when the federal government turns a program into a block grant, go here to see the Center on Budget and Policy Priorities’ report “Funding for Housing, Health, and Social Services Block Grants Has Fallen Markedly Over Time.”
Hospitals Failing to Prevent Avoidable Readmissions
Hospitals continue to fail to prevent many avoidable readmissions, a new study in JAMA Internal Medicine has concluded.
Among the causes? Patients who shouldn’t have been admitted through the ER in the first place, post-discharge instructions written at too high a level for patients, failure of patients to keep follow-up appointments, and hospitals discharging patients too soon.
Two of those causes – hard-to-understand discharge instructions and difficulty keeping follow-up appointments – as problems that are especially prevalent within the kinds of communities served by Pennsylvania’s safety-net hospitals.
In all, the study of 12 academic medical centers concluded that 15 percent of readmissions were preventable, 12 percent were likely unpreventable, and there was about a 50 percent chance of preventing another 15 percent of readmissions.
For a look at the problems the study identified and its recommendations for addressing them, go here to see the JAMA Internal Medicine article “Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients.”
IOM Weighs in on Social Determinants Training
If patients’ symptoms and conditions are the product of who they are, where they are from, and how they have lived, can better understanding those circumstances help providers serve those patients more effectively?
Increasingly the answer to that question has been yes, it can, and now, the National Academies of Science, Engineering, and Medicine and the Institute of Medicine have proposed an approach to training caregivers on the social determinants of health. Their new publication, A Framework for Educating Health Professionals to Address the Social Determinants of Health, notes that
The World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These forces and systems include economic policies, development agendas, cultural and social norms, social policies, and political systems. Health inequities, “the unfair and avoidable differences in health between groups of people within countries and between countries” (WHO, 2015b), stem from the social determinants of health and result in stark differences in health and health outcomes.Â
SNAP has long maintained that the socio-economic challenges their patients face – all important social determinants of health – make serving their low-income communities more challenging and more complex than the patients served by the typical community hospital in Pennsylvania today.
The report’s framework addresses such issues as diversity and inclusion, the importance of a diverse workforce, community participation, health professions education, and more. To learn more about how understanding the social determinants of health might lead to better care and healthier populations, go here to see the National Academies of Science, Engineering, and Medicine and the Institute of Medicine publication A Framework for Educating Health Professionals to Address the Social Determinants of Health.
GAO Looks at Supplemental Medicaid Payments
Following up its own 2012 report that identified more than 500 hospitals receiving supplemental Medicaid payments that resulted in Medicaid payment surpluses, the U.S. Government Accountability Office has taken a broader look at supplemental payments state Medicaid programs make to hospitals and how those payments are used.
In a limited study of hospitals in four states, GAO found that some hospitals used supplemental payments for purposes other than serving Medicaid patients and the uninsured – purposes such as ordinary operations, capital purchases, a poison control center, even a helicopter. GAO also found that hospitals were more likely to receive such payments if local funding was used to draw down federal Medicaid matching funds. In some places, hospitals with local governments willing to finance the payments were more likely to receive them than hospitals located in places without such local support.
The GAO recommended that the Centers for Medicare & Medicaid Services take stronger steps to ensure that supplemental Medicaid payments are linked to the provision of Medicaid services and that CMS not permit states to make those payments contingent on local financing.
Learn more about why the GAO looked at supplemental Medicaid payments, what it learned, and what it recommended in the report Federal Guidance Needed to Address Concerns About Distribution of Supplemental Payments.