On October 23, State Health and Value Strategies is hosting a webinar that will explore state options for regulating provider risk-bearing organizations. The push to better manage costs and improve quality is resulting in payment models that transfer financial risk and accountability from payers to providers. An increasing number of provider organizations are entering into risk-based contracts with payers where they are accepting the financial risk of care. This financial liability is often shared with payers, and maximum risk exposure is typically capped. During the webinar, technical experts from Bailit Health will review approaches states could take to overseeing their risk-bearing organizations and highlight examples from states that have elected to regulate to protect against provider insolvency.
On October 1, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar, facilitated by experts at Manatt Health on the long-anticipated proposed rule released by the Department of Homeland Security (DHS) on September 22. The proposed rule seeks to change how DHS determines whether immigrants—when seeking admission to the United States, an extension of their stay, or status change to become a legal permanent resident—are “likely at any time to become a public charge” (i.e., dependent on the government for financial support). Consequentially, being determined a “public charge” may put immigration status at risk. The webinar reviewed the proposed rule and its potential impacts on consumers, states and providers. Specifically, we highlighted the key ways the proposed rule departs from current guidance, with a particular focus on the implications for Medicaid and other health-related public benefits, and how the proposed rule may impact consumers’ access to certain benefits. Click here for the webinar slides.
The Effects of Medicaid Expansion under the ACA: Select Articles Published Between January 1, 2018 and August 31, 2018
Thirty-three states and the District of Columbia have expanded Medicaid since 2014. As experience with Medicaid expansion grows, states and independent researchers are generating studies that evaluate its impacts at both the state and national levels. This resource highlights articles published since January 2018 that report on those impacts, organized by health access and outcomes, economic impacts, and coverage impacts.
State Health Policy Highlights: Service Integration and Joint Accountability Across State Agencies and Programs
Health status is largely influenced by factors outside the health care delivery system, particularly for low-income populations. State efforts to improve health and reduce health disparities through the lens of medical care alone will miss opportunities for individuals, particularly the most vulnerable and their communities. As more states focus broadly on population health goals, they seek to employ and coordinate a variety of health and other resources on targeted efforts. This State Health Policy Highlight profiles three State Health and Value Strategies (SHVS) issue briefs that provide states with practical approaches to improve individual and population health and create joint accountability across health care and other sectors.
There is an extensive body of evidence that shows social determinants of health (SDOH) play a powerful role in shaping health and health outcomes. State policymakers are increasingly focused on SDOH because of the influence they have on health, health care outcomes and Medicaid spending. As state Medicaid agencies consider addressing SDOH, there are a range of models they can employ. State Health and Value Strategies (SHVS) has published resources and hosted webinars with information for state health officials on approaches to addressing SDOH. This State Health Policy Highlight profiles two issue briefs and a webinar produced by SHVS on the topic of how state Medicaid programs can address SDOH.
Faced with a fluid federal regulatory environment, many states continue to encounter challenges in stabilizing their individual health insurance markets, including large premium increases and declining insurer participation. One solution to continued market instability is a state-based reinsurance program similar to the federal program that reduced premiums by more than 10 percent per year from 2014 to 2016. The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.
Using Hospital Admission, Discharge, and Transfer (ADT) Data to Coordinate Care: Lessons from Tennessee and Washington
On September 6, 2018, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar on effective use of admissions, discharge, and transfer (ADT) data. Considered to be the most relevant real-time electronic data for health care providers, ADT data, if used effectively, can help states improve overall health of their populations. This webinar featured the use of ADT data feeds to coordinate care for patients with behavioral health and other complex care issues by two states, Tennessee and Washington. Presenters provided an overview of their respective state programs, including operational and financing strategies, linkages to quality metrics and outcomes, and alignment with other statewide payment and delivery system efforts. Presenters also shared lessons learned and advice to states.
On October 12, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar, facilitated by experts at Bailit Health, on a new suite of publicly available resources that support states in their measure selection, alignment and performance benchmarking efforts. The Buying Value Benchmark Repository builds upon the Buying Value Measure Selection Tool and is a downloadable database of non-HEDIS and modified HEDIS measures that states and regional health improvement collaboratives are using for reporting, payment or other purposes. During the webinar technical experts from Bailit Health provided an overview of the repository and discussed how states can both utilize the tool and contribute measures to it. The webinar also reviewed the resources available through Buying Value to support measurement selection. These resources are publicly available to download and use, and the Measure Selection Tool can be customized to support measure alignment and selection processes.
Work and Community Engagement Requirements in Medicaid: State Implementation Requirements and Considerations
The Centers for Medicare & Medicaid Services (CMS) has approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire, and additional states have submitted or are poised to submit similar waivers. Manatt Health has produced a series of charts that outline the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program. This information is intended to highlight for states the complexity of administrative tasks associated with implementing a work/CE requirement.
An increasingly common feature of health care payment models is the transfer of financial risk from payers to providers for health care services delivered to a defined population of patients. In these “value-based payment” models, providers accept financial responsibility should spending for most, or all, services for an attributed patient population exceed targeted levels. This financial liability is often shared with payers, and maximum risk exposure is typically capped. This issue brief explores options for states as they consider oversight of risk-bearing organizations, with a focus on states that have elected to act to protect against provider insolvency.