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红领巾瓜报 Insights: Your source for healthcare news, ideas and analysis.

红领巾瓜报 Insights 鈥� including our new podcast 鈥� puts the vast depth of 红领巾瓜报鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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147 Results found.

Brief & Report

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016

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This issue brief was released Oct. 15 by the Kaiser Family Foundation鈥檚 Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15th annual budget survey of Medicaid officials, 鈥淢edicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.鈥�

红领巾瓜报 Managing Principal Kathleen Gifford, Principal Barbara Edwards and Senior Consultant Jenna Walls authored this brief with Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

The years 2015 and 2016 continue a period of significant change and transformation for Medicaid programs. With slow but steady improvements in the economy following the Great Recession, Medicaid programs across the country were focused on implementing a myriad of changes included in the Affordable Care Act (ACA), pursuing innovative delivery and payment system reforms with the goals of assuring access, improving quality and achieving budget certainty, and continuing to administer this increasingly complex program.

However, these changes to Medicaid policy take place in the larger context of states budgets. Unlike the Federal government, states generally have balanced budget requirements, taking into account the amount of revenue coming in from a state鈥檚 own resources as well as federal revenues. State lawmakers must balance competing priorities across budget expenditure categories. Even in years of economic growth, state lawmakers face this pressure of balancing priorities.

This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states:

  • Alaska
  • California
  • Tennessee
Brief & Report

Michigan Medicaid Managed Care Results Announced

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In previous editions of The Michigan Update (most recently in August) we have reported on the Michigan Department of Health and Human Services’ (MDHHS) release of a Request for Proposals (RFP) to re-procure its Medicaid managed care contracts. The RFP was released in early May with bidder responses due in early August. This procurement is for at least five years, with the possibility of up to three one-year extensions. The total cost of the procurement for five years is estimated to be $35 billion. On October 13, 2015 the State of Michigan announced the much anticipated results of the re-procurement.
 
Since the prices paid to the contracted HMOs are set by the state, the health plan selection was based solely on technical scores. The HMOs were required to bid on entire regions, which were configured differently than in the past. The reconfiguration required a number of the HMOs to expand their service areas to meet the “entire region” requirement. The new regional configuration appears in the map below:
Note: Region 2 and Region 3 were required to be bid together.

The RFP included a proposed number of HMOs that would be awarded contracts for each of these regions. To minimize disruptions for Medicaid enrollees, in each region (other than the Upper Peninsula) the number of plans selected was one more than the proposed maximum number of awards for that region. Proposals from the HMOs were evaluated based on demonstrated competencies and also statements of their proposed approaches to many new initiatives related to population health, care management, behavioral health integration, patient-centered medical homes, health information technology and payment reform.

Not every HMO was successful in each region for which it submitted a bid. Two plans were not successful in any region. One is Sparrow PHP, which is an incumbent plan in Region 7. The other is MI Complete Health (Centene/Fidelis SecureCare) which is not currently a Medicaid plan in any part of the state but does have an Integrated Care Organization contract to serve dual Medicare/Medicaid enrollees in Macomb and Wayne counties as part of Michigan’s dual eligible demonstration.

The following table indicates the regions for which each bidding HMO was and was not successful. In addition, the numerical values show the rank of that plan based on their evaluation scores among the successful bidders for each region. If an HMO is a current contractor for all counties in a region, their result is shaded green. If the HMO is a current contractor for some but not all counties in a region, their result is shaded yellow. The number of Medicaid enrollees currently served in each of the regions, eligible through both “traditional” Medicaid and the Healthy Michigan Plan, appear in the bottom row on the table; across all regions, this is more than 1.6 million Medicaid enrollees.

Technical Evaluation Results

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Brief & Report

红领巾瓜报 Principals Designated NCQA PCMH Certified Content Experts

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红领巾瓜报 Principals Lori Weiselberg and Lynn Dierker recently achieved the National Committee for Quality Assurance鈥檚 (NCQA) Patient-Centered Medical Home Certified Content Expert™ (PCMH CCE™) status.

is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Its certified content experts are required to complete two NCQA educational seminars, pass a comprehensive exam and commit to continuous learning and recertification to maintain the credential.

红领巾瓜报鈥檚 team of NCQA Patient-Centered Medical Home Certified Content Experts™ includes Principal Linda Follenweider and Senior Consultants Melissa Corrado and Jodi Bitterman. 红领巾瓜报 has deep PCMH experience and expertise 鈥� we鈥檙e ready to help your team.

Brief & Report

红领巾瓜报鈥檚 Edwards Co-authors Health Affairs MLTSS Policy Brief

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红领巾瓜报 Principal Barbara Edwards is co-author of the Health Affairs health policy brief 鈥淩ebalancing Medicaid Long-Term Services and Supports.鈥� The brief examines Medicaid鈥檚 support of more flexible community-based long-term services and supports, including what鈥檚 at issue, the current debate and what鈥檚 next.

Brief & Report

Total Cost of Care Regional Initiative Phase 1 Evaluation Complete

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With support from the Robert Wood Johnson Foundation (RWJF), 红领巾瓜报 (红领巾瓜报) recently conducted a qualitative evaluation of Phase 1 of the RWJF Total Cost of Care and Resource Use (TCOC) pilot. The TCOC framework, developed by HealthPartners and endorsed by the National Quality Forum (NQF), is an analytical tool that measures cost and resource use for virtually all care used by individuals. According to HealthPartners, TCOC is designed to 鈥渟upport affordability initiatives, to identify instances of overuse and inefficiency, and to highlight cost-saving opportunities.鈥�

In 2013 the RWJF funded five regional health care improvement collaboratives (RHICs) to measure TCOC using multi-payer commercial data, engage stakeholders, publicly report the measures associated with primary care physician practices or groups by December 2014, and work collaboratively with each other. RWJF also funded the to lead and coordinate this effort to test a standardized TCOC approach in multiple regions and establish national benchmarks for cross-regional analysis.

The initial 18-month grants (11/1/2013 – 4/30/2015) constituted Phase 1 of the pilot; in spring 2015, RWJF awarded these grantees and up to three additional regions Phase 2 funding to continue and expand their efforts. The objectives of 红领巾瓜报鈥檚 evaluation were to assess the RHICs鈥� early experiences with a collaborative approach to a standardized TCOC framework, and to identify promising practices and critical lessons for other community collaboratives, policymakers, funders, and stakeholders.

To learn about the key accomplishments, challenges and other lessons learned, download the complete report below.

Brief & Report

KCMU Issue Brief Profiles Newer Programs in Medicaid Health Homes

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红领巾瓜报 Managing Principal Mike Nardone and Julia Paradise authored the recently released issue brief, “Medicaid Health Homes: A Profile of Newer Programs” for the Kaiser Commission on Medicaid and the Uninsured (KCMU).

The Affordable Care Act (ACA) established a new state option in the Medicaid program to implement “health homes” for individuals with chronic conditions, giving states a new tool to develop models of care designed to improve care coordination and reduce costs for high-need populations. In August 2012, the KCMU issued a examining the first six health home programs. This update profiles health home programs in the nine states that have taken up the option in the intervening two years – Alabama, Idaho, Maine, Maryland, Ohio, South Dakota, Washington, Wisconsin, and Vermont.

States have implemented health home programs in a variety of ways, reflecting different targeting priorities, underlying delivery and payment systems, and visions of delivery system reform, as well as other state-level factors. This issue brief identified both themes and diversity in the more recent health home programs in a number areas, including geographic scope, target population, health home providers, payment, fee for service versus managed care, and HIT.

Brief & Report

Kaiser Releases Medicaid, CHIP Enrollment Snapshot Reports

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On June 3, the Kaiser Commission on Medicaid and the Uninsured released its 鈥淢edicaid Enrollment Snapshot: December 2013鈥� issue brief.

Authored by Kaiser鈥檚 Laura Snyder and Robin Rudowitz and 红领巾瓜报鈥檚 Eileen Ellis and Dennis Roberts, the report indicates that as of December 2013, nearly 55.4 million people were enrolled in Medicaid. That鈥檚 an increase of 585,000 enrollees from the prior year, but the slowest growth since before the Great Recession.

The report examines changes in monthly Medicaid enrollment from December 2012 to December 2013 and the factors that influenced those changes in a variety of ways. Factors of particular note include:

  • Continued improvement in economic conditions resulted in slower Medicaid enrollment growth.
  • Early expansion of Medicaid in some states, as well as successful outreach and enrollment efforts for new Marketplaces pushed enrollment up in some states.
  • Problems implementing new enrollment systems for the Federally Facilitated Marketplace (FFM) and State Based Marketplaces (SBM) put downward pressure on Medicaid enrollment growth.

Click here to access the report.

The Commission also released its 鈥淐HIP Enrollment Snapshot: December 2013鈥� issue brief.

Authored by 红领巾瓜报鈥檚 Vern Smith and Kaiser鈥檚 Laura Snyder and Robin Rudowitz, the report shows nearly 5.8 million children were enrolled in the Children鈥檚 Health Insurance Program (CHIP) in December 2013. That represents a 3.1 percent increase from 2012.

This report examines changes in monthly CHIP enrollment between December 2012 and December 2013. Some findings of interest include:

  • Continued improvement in economic conditions likely resulted in both some growth as children shifted from Medicaid to CHIP and some declines as family incomes continued to increase above CHIP eligibility levels.
  • Successful outreach and enrollment efforts for new Marketplaces likely pushed enrollment up in some states.
  • Problems implementing new enrollment systems for the Federally Facilitated Marketplace (FFM) and State Based Marketplaces (SBM) likely put downward pressure on CHIP enrollment growth.

Click here to access the report.

Brief & Report

Issue Brief Explores Clinical Management Apps

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红领巾瓜报 partnered with The Commonwealth Fund to develop an issue brief examining consumer mobile health applications, or apps. 红领巾瓜报 Managing Principal Sharon Silow-Carroll and Principal Barbara Markham Smith explore the use of these apps in 鈥淐linical Management Apps: Creating Partnerships Between Providers and Patients.鈥�

The market for health and wellness apps for use on smart phones, tablets, and other mobile devices is still in its infancy, but is expected to double by the end of 2013. The brief explores current apps on the market, and focuses on those that connect patients with their clinicians and help them manage chronic conditions. It reports patient views about clinical management apps, and how these tools are impacting health outcomes. The brief also takes a look at the challenges to develop and spread the use of clinical management apps and what the future might hold for these tools, particularly for reaching vulnerable populations.

Brief & Report

红领巾瓜报-authored report for SAMHSA-HRSA looks at health homes

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The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) engaged 红领巾瓜报 (红领巾瓜报) to outline key areas of a recently enacted provision of the Affordable Care Act that permits Medicaid coverage of health homes, a service delivery model supporting care coordination and related supports for individuals with chronic conditions, including those with mental and substance use conditions.

红领巾瓜报鈥檚 team of Managing Principal Jennifer N. Edwards and Principals Katharine V. Lyon, Juan Montanez, and Alicia D. Smith created 鈥淔inancing and Policy Considerations for Medicaid Health Homes for Individuals with Behavioral Health Conditions: A Discussion of Selected States鈥� Approaches.鈥�

This report has three purposes:

  • To describe the overarching policy considerations for states and potential providers of health home services
  • To discuss the roles of quality measurement and health information technology (HIT)
  • To explore options and considerations for developing reimbursement methodologies and establishing payment rates.

The report provides an overview of health home service design and Medicaid State Plan Amendment development. It outlines the processes that may be necessary for state governments to work with SAMHSA and CMS in order to receive consultation and obtain approval for Medicaid health home services. 红领巾瓜报 authors also offer observations and recommendations for states interested in implementing the benefit.

Released this week, the report was developed for the SAMHSA-HRSA Center for Integrated Health Solutions with funds under grant number 1UR1SMO60319-01 from SAMHSA-HRSA, U.S. Department of Health and Human Services. The CIHS promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings.

Brief & Report

New report highlights need to address long-term care demands

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红领巾瓜报 (红领巾瓜报) partnered with AARP Public Policy Institute and the National Association of States United for Aging and Disabilities (NASUAD) to highlighting the challenges facing states in providing long-term services and supports (LTSS).

红领巾瓜报 Senior Consultant Jenna Walls is one of the authors of 鈥淎t the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint.鈥� Released July 16, the report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms under way and trends across the country.

Brief & Report

Issue brief examines Medicaid outreach, enrollment strategies

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A continuum of coverage options take effect under the Affordable Care Act (ACA) in 2014. In advance of this milestone, the is offering a series of issue briefs that profile Medicaid outreach and enrollment strategies to inform efforts to implement the ACA.

红领巾瓜报 Principal Jennifer Edwards and Consultant Diana Rodin worked with Samantha Artiga, of the聽 Kaiser Family Foundation, to produce the recently released It is the second installment in the 鈥淕earing up for 2014鈥� series which highlights lessons learned from Medicaid and CHIP outreach and enrollment strategies . This brief profiles a new initiative of the to facilitate coverage renewals through a systematic, technology-based reminder system coupled with one-on-one assistance.

The profiled a successful initiative among health centers in Utah to provide one-on-one Medicaid enrollment assistance.

 
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
Aetna Better Health
(CoventryCares)
 
 
 
 
No
 
 
Yes – 4
Yes – 4
Yes – 7
Blue Cross Complete
 
 
 
Yes – 3
 
Yes – 5
Yes – 3
 
Yes – 3
Yes – 5
HAP Midwest Health Plan
 
 
 
 
 
Yes – 6
 
 
No
No
Harbor Health
Plan
 
 
 
 
 
 
 
 
 
Yes – 8
McLaren Health
Plan
 
Yes – 3
Yes – 3
Yes – 4
Yes – 3
Yes – 3
Yes – 2
Yes – 3
Yes – 6
Yes – 4
Meridian Health Plan of MI
 
Yes – 1
Yes – 4
Yes – 5
Yes – 2
Yes – 4
No
Yes – 5
Yes – 5
Yes – 3
MI Complete Health
(Centene/Fidelis)
 
 
 
 
 
 
 
 
No
No
Molina Healthcare
of MI
 
Yes – 4
Yes – 1
Yes – 1
Yes – 1
Yes – 2
Yes – 1
Yes – 1
Yes – 1
Yes – 2
Priority Health Choice
 
No
No