Looking at Health System Transformation Through a Health Equity Lens

The latest Community Catalyst blog in our series on health system transformation looks at the changes in the health system through a health equity lens, highlighting both the risks and the opportunities to reduce health disparities. Specifically, Community Catalyst is focusing on risk adjustment, health data collection, the inclusion of community-based providers and particularly of Community Health Workers in the new health care workforce, promoting cultural competence, reducing implicit bias and promoting population health.

Opposition Emerging to CMS Proposal to Alter Payments to Plans

The Centers for Medicare and Medicaid Services (CMS) recently announced it would modify its risk-adjustment model to correct for underpayments to plans serving large numbers of dually eligible individuals. Modern Healthcare reports on opposition to these changes that is emerging from some health plans. Because the CMS proposal suggests reductions in payments to plans that serve large numbers of healthier Medicare Advantage enrollees, plans serving that population are objecting to the CMS proposal. Last month, Community Catalyst submitted comments on the CMS proposal.

Challenges Remain in Transforming Care for Mental Illness

A Harvard Medical School study claims that alternative payment methods have thus far not benefited individuals with mental illness. The study looked at the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract, first implemented in 2008, and found that while the new model has shown some success in improving care for people with chronic physical illnesses like diabetes, it has not yet helped people with anxiety, depression, bipolar disorder, schizophrenia and other mental illnesses. As plans and providers struggle to make payment and other changes to the health system that will improve behavioral health care, they also face the stark reality of inadequate provider capacity. A provocative article in Governing discusses the dilemma presented by this nationwide crisis and notes the calls by some for a return of psychiatric hospitals to care for people with serious behavioral health diagnoses.

APCD Debate Reaches the Supreme Court

Earlier this month, the United States Supreme Court heard arguments in a case that could threaten all-payer, all-claims databases (APCDs) nationwide: Gobeille v. Liberty Mutual . The case emerges from Vermont, which is one of 18 states with a data collection law. State advocates, including our partners in Oregon (OSPIRG and AARP) are joining the state’s attorney general to defend a state’s ability to require self-insured companies to report their medical claims data to APCDs. If Vermont loses, it would trivialize Oregon’s APCD by cutting 23 percent of Oregonians from the database unless their employers voluntarily submitted claims.

Memo from CMS on Stipends or Non-Monetary Incentives for Advisory Committees

The Centers for Medicare and Medicaid Services (CMS) posted a memo addressed to Medicare-Medicaid Plans (MMPs) regarding stipends and non-monetary incentives for enrollees who are members of MMP advisory committees. Under the Financial Alignment Initiative, MMPs are required to set up consumer advisory councils. MMPs have asked CMS for clarification on whether providing stipends or non-monetary incentives are considered marketing activities. The guidance clarifies that these are not considered marketing activities and the MMPs are permitted to provide such stipends or non-monetary incentives. However, MMPs are encouraged to remain mindful of the federal Anti-Kickback Statute, which prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal health care program business (42 USC, Section 1320a-7b) and to direct any questions about that statute to the Office of Inspector General.

Community Catalyst’s online resource, Meaningful Consumer Engagement: A Toolkit for Plans, Provider Groups and Communities, includes suggestions for health plans on providing appropriate incentives to consumers, both to help make their participation and attendance at meetings feasible, and to show appreciation for their contribution of time and energy.