Striking a Solomon-like compromise, Maryland’s Health Services Cost Review Commission (HSCRC), which annually sets payment rates for hospitals across the state, increased rates for the coming fiscal year more than originally proposed but not to the level requested by the hospital industry. The commission approved a 2.16 percent rate increase for the first half of the fiscal year and a 3.28 percent rate increase for the second half. Central to the debate was the amount of money hospitals need to make investments in prevention and public health programs, with the HSCRC saying hospitals have already been provided with adequate funding for those investments and hospitals saying they need more money.
Today, the Executive Office of Health and Human Services (EOHHS) released a draft of its 1115 waiver proposal. Under this proposal, MassHealth beneficiaries would be placed into Accountable Care Organizations in which doctors and hospitals are paid set budgets to treat patients. EOHHS will hold two public listening sessions to receive comments about the draft proposal. Written comments will be accepted until July 15.
In other news, a new report argues that the 2012 Massachusetts Health Care Payment Reform Law can point to real progress to date in slowing the rate of health care cost growth through a variety of mechanisms. This summary of how the law is working argues that the state can point to real progress to date. In 2011, health insurance premiums in Massachusetts were $2,000 above the national average. By 2014, they were only $1,000 above the national average. It seems clear that the law has had a significant impact on price negotiations between payers and providers and moderated cost growth in the state. Figures for 2015 will be available in the fall, which will indicate if the progress documented thus far has continued. Of concern to all stakeholders are the prices of prescription drugs, which are a proving to be significant obstacle for slowing cost growth.
In May, the Rutgers Center for State Health Policy released a report on lessons learned from the implementation of the New Jersey Medicaid Accountable Care Organization
Demonstration. The report details five major challenges and points to several key lessons:
- The detailed, prescriptive character of the founding legislation created implementation challenges and may have undercut the ability of the demonstration to reach its full potential.
- Demanding, numerical targets for ACO participation by primary care providers along with limited data that the state could share created formidable implementation challenges and weakened the ability of the ACO demonstration to achieve its full potential.
- Launching Medicaid ACOs without additional state funding impeded implementation and necessitated alternative support from private sources to sustain the initiative.
- The voluntary participation of Medicaid managed care organizations envisioned by the founding ACO legislation heightened the transaction costs for applicants and may weaken the ability of the ACOs to achieve their full potential.
- Assuring the timeliness and validity of quality metrics, promoting greater congruence among the measures used by Medicaid ACOs and other payers, and pairing the reporting costs associated with the metrics may well increase prospects for the diffusion of successful ACOs.
The state Department of Health has provided a long-awaited update on enrollment in the state’s dual eligible demonstration project, known as FIDA. While most figures are more than five months out of date, they continue to show low enrollment in the demonstration and high optout rates.
The Department of Health has also released a funding opportunity for Community Based Organizations (CBOs) interested in participating in the state’s DSRIP (Delivery System Reform Incentive Payment) program. DSRIP has been criticized by many consumer groups in New York for failing to adequately involve CBOs in the hospital-driven program. Up to $7.5 million in planning grants will be made available to CBOs seeking to participate more fully in DSRIP. In other DSRIP news, as the project enters its second year of operation spending is well behind schedule. While some of the causes for slow spending are timing-related and may prove to have only a temporary impact, the lack of good data from the state could prove to be a more troublesome long-term problem.
In response to these and other health system transformation reforms, the Health Care for All New York coalition developed a set of principles to provide advocates with a framework for consumer-friendly payment and delivery system reform.
On June 1, North Carolina’s Department of Health and Human Services (DHHS) submitted a Section 1115 waiver demonstration proposal to the Centers for Medicare and Medicaid Services (CMS). Under the proposed waiver, DHHS will contract with three statewide managed care plans to operate alongside local health care provider-led managed care entities. The program, scheduled to begin in 2019, is expected to serve 1.5 million Medicaid beneficiaries. DHHS is also working with the Eastern Band of Cherokee Indians to develop a tribal managed care entity, potentially the first of its kind. It also intends to develop a statewide plan for children in foster care. The waiver proposes implementing managed long-term services and supports (LTSS) for Medicaid-only beneficiaries, including state plan LTSS services and the services authorized under two 1915(c) waivers – Community Alternatives Program for Children and Community Alternatives Program for Disabled Adults. Medicare-Medicaid beneficiaries (“dual eligible”) are excluded from the initial demonstration.
The Centers for Medicare and Medicaid Services signed off on a preliminary plan submitted by the Ohio Department of Developmental Disabilities that will give more than 36,000 people with disabilities more choices for community-based services. Ohio is the third state, after Tennessee and Kentucky, to meet new federal requirements designed to move people with disabilities away from institutional-style settings and toward community services. All states must comply with new federal regulations established in 2014. Ohio faced a 2019 deadline to implement the rules or potentially lose federal funding, which covers 60 percent of all money spent on programs for persons with disabilities and older adults.
The Pennsylvania Department of Human Services announced last week its decision to lengthen the transition time for the start of Community HealthChoices (CHC), the commonwealth’s managed long-term services and supports program. Instead of beginning on January 1, 2017, the first phase (in the Southwest region) is now delayed until July 1, 2017. This decision does not impact the start of the program in other regions: CHC will launch in the southeast region in January 2018 and in the northwest, Lehigh-Capital and northeast regions in January 2019.
The Rhode Island Executive Office of Health and Human Services posted a new fact sheet on the Integrated Care Initiative, the state’s dual eligible demonstration project. The new program is called Neighborhood Integrity and will be offered through Neighborhood Health Plan of Rhode Island, the sole plan participating in the demonstration. The opt-in enrollment process started on June 1 with 500 eligible individuals receiving letters.
Consumer advocates in Washington are working to bring a robust consumer voice to the state’s latest health system transformation project. The state’s newly-created Accountable Communities of Health are bringing together stakeholders from across the health care and social service systems in a collective decision-making process to improve health care and health outcomes. These cross-sectoral partnerships seek to increase collaboration, better coordinate care, reduce costs, address social determinants of health and increase equity in health outcomes.