On October 23, State Health and Value Strategies hosted a webinar that explored 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 reviewed approaches states could take to overseeing their risk-bearing organizations and highlighted examples from states that have elected to regulate to protect against provider insolvency. Click here to access webinar slides
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.
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.
On July 24th, the Robert Wood Johnson Foundation State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, hosted a webinar to review the Stewart v. Azar decision and its potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. During the webinar, we reviewed the court’s findings and any Centers for Medicare & Medicaid Services guidance. Even in states not pursuing work/community engagement requirements, the court’s findings may shape what type of analysis will be necessary to demonstrate that future waivers advance the objectives of the Medicaid statute.
Waivers of the Institutions for Mental Disease (IMD) Exclusion: Emerging Opportunities and Challenges
On June 21, the Robert Wood Johnson Foundation’s State Health and Value Strategies program, together with technical assistance experts from Manatt Health, hosted a webinar to discuss the status of state efforts to secure waivers to use federal Medicaid funding to provide care in Institutions for Mental Disease (IMD). The webinar reviewed the requirements states must meet to secure an IMD waiver; the status of requests and approvals; and issues and opportunities arising as states pursue and increasingly implement the IMD waiver. We were joined by leadership from the New Jersey Department of Human Services, which received approval of its IMD waiver in October 2017 and is now in the implementation phase.
In recent months, several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. In this webinar, the Robert Wood Johnson Foundation’s State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, examined the central considerations that a state must take into account when developing a Medicaid buy-in proposal; the primary models for state-administered Medicaid buy-in proposals, and the administrative considerations and authorities needed for each model. The webinar also reviewed Section 1332 waiver authority and related deficit neutrality and pass-through funding implications that states will want to consider as they craft their buy-in proposals. We also highlighted states’ current efforts to develop buy-in initiatives.
The U.S. Department of Health & Human Services released on April 9, 2018 its annual Notice of Benefit and Payment Parameters, a collection of policies governing the ACA’s marketplaces, insurance reforms, and premium stabilization programs. The first such annual notice issued under the Trump Administration, it contains a number of provisions that require state officials to make important decisions on short notice that will affect plan benefits, premiums, and marketplace operations. State Health and Value Strategies hosted a webinar, together with experts Sabrina Corlette and Justin Giovannelli from Georgetown’s Center on Health Insurance Reforms, Joel Ario from Manatt Health and Jason Levitis, to help participants untangle the rule and its many implications for states.
Global budgeting is an innovative payment approach for rural hospitals that can enhance financial solvency and advance population health. Hospitals with global budgets know their revenues in advance of the year and so can concentrate on providing the services their communities need as well as on the prevention and management of chronic illness. Maryland rural hospitals have received global budgets since 2010; selected Pennsylvania rural hospitals will be starting on global budgets soon.
Analysis of the Trump Administration’s Proposed Short-Term Health Plan Rule: Implications for States
The Secretaries of Health and Human Services, Treasury, and Labor released a proposed rule to implement the President’s October 12, 2017 executive order calling for expanded availability of short-term limited duration health plans that do not have to comply with Affordable Care Act standards. The proposed rule would relax current federal rules by allowing short-term plans to be sold for a duration of up to 12 months. It also modifies required consumer disclosures about these products.