CMS Releases Findings on Medicare Risk Adjustment Study
The Centers for Medicare and Medicaid Services (CMS) released a memo highlighting findings on a study conducted on the CMS-Hierarchical Condition Category (HCC) risk adjustment model for predicting costs of dual eligible beneficiaries. Findings reveal that the Medicare risk adjustment model (the “HCC”): over predicts for partial dual eligibles living in the community; under predicts for full dual eligibles living in the community; and fairly accurately predicts for dual eligibles in institutions and non-duals living in the community. CMS has proposed revising the approach to create six different categories for Medicare beneficiaries living in the community: (1) Full benefit dual aged; (2) Full benefit dual disabled; (3) Partial benefit dual aged; (4) Partial benefit dual disabled; (5) Non-dual aged; and (6) Non-dual disabled. The proposed changes are open for public comment until November 25. The final changes would apply to Medicare Advantage payments in 2017.
Community Health Workers Show Great Potential for Improving Health Outcomes
A small Community Health Worker (CHW) program in Los Angeles is working hard to improve the health of patients with complex conditions. Los Angeles County is testing a program with 25 CHWs and 150 patients, many of whom have mental health issues, substance abuse problems and multiple chronic diseases. The project includes a rigorous evaluation component that compares the costs and health outcomes of patients in the program against similar patients without assigned workers. For those seeking more information on CHWs, Community Catalyst has recently released Trusted Voices: The Role of Community Health Workers in Health System Transformation. This new resource provides an overview of the evidence supporting the employment of CHWs and the opportunities and challenges for integrating CHWs in health care delivery teams.
Update from CMS on Quality Measures
The Medicare-Medicaid Coordination Office (MMCO) and the Center for Medicaid and CHIP (Children’s Health Insurance Program) Services (CMCS) are combining efforts on measurement development for low-income populations for potential use in various federal and state programs. Building off of the National Quality Forum’s Measure Applications Partnership (MAP) recommendations, MMCO has an interest in developing measures across programs that serve a population that is either all or largely dually eligible. CMCS has an interest in developing new measures and testing existing measures for Medicaid enrollees across the priority areas emphasized in the Medicaid Innovation Accelerator Program (IAP) and for all enrollees in states’ long-term care services and supports (LTSS) programs. CMS has contracted with Mathematica Policy Research to develop, maintain, reevaluate and/or refine existing quality measures across program areas.
Leading Health Care Thinker Counsels Patience with Dual Eligible Demonstration
In an opinion piece in CommonWealth Magazine, John McDonough, a key architect of both the Massachusetts health reform law and the Affordable Care Act, argues that Massachusetts should stay the course on its dual eligible demonstration, the One Care program. The program has struggled through a difficult initial 18 months, and both the state and CMS are working to make mid-course corrections to improve the program. McDonough argues that One Care is tackling our health system’s starkest shortcomings and, if given adequate time and support, could serve as a national model.
Accountable Care Organizations (ACOs) in the Spotlight
A Centers for Medicare and Medicaid Services report released in August showing that ACOs have not yet saved the government any money has garnered mixed interpretations. Kaiser Health News interviewed five experts about whether or not the nationwide experiment with ACOs is working and found significant disagreement. Of course, saving money is only part of the story. As important is making sure that ACOs also improve the quality of care and health outcomes. Harvard Business Review has published an article highlighting three general principles that can guide Accountable Care Organizations (ACOs) seeking to improve quality scores. The principles include:
- Start simple and build gradually
- Focus on “small picture” decisions and behaviors
- Measure and reward desired behaviors
Further Study Slated for Bundled Payments for Cancer Treatment
The recent Centers for Medicare and Medicaid Services announcement that Medicare will test bundled payment and quality measurement for an episode of care associated with hip and knee replacements has gotten a lot of attention. Now, from UnitedHealthcare comes news that it will expand its high-profile test of whether bundled payments for chemotherapy can help slow rising cancer treatment costs. Results from United’s initial pilot program showed that the overall cost of cancer care for patients in the study dropped by 34 percent, even as spending on chemotherapy drugs rose significantly. To try to understand this counter-intuitive finding, United has announced that 500 additional oncologists will join the study, bringing the total to about 650 physicians in seven states.