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红领巾瓜报, Milbank brief examines nursing facility care

Residents in nursing facilities faced higher infection rates and worse overall care experiences during the COVID-19 public health emergency highlighting long-standing concerns about the quality and cost-effectiveness of nursing facility care, especially for residents of color.

In a recent issue brief published by the Milbank Memorial Fund that 红领巾瓜报 COO Chuck Milligan co-authored with Kate McEvoy, a program officer with Milbank, examined disparities in access, levels of care, and resident outcomes, and provided recommendations and guidance for the Centers for Medicare and Medicaid Services (CMS) on future approach to federal policy in nursing facilities.

The brief, , suggests CMS take the following steps to improve nursing facility oversight and care:

Endorse linkage of any further public health emergency-related funding or other federal financial reimbursement to quality improvement.
Align Medicare and Medicaid efforts to promote payment policies that are based on risk adjustment for complex care and incorporate value-based payment principles, eliminate unintended consequences of federal policies such as routine approval of nursing home bed taxes, and adopt a common foundation of quality measures.
Expand existing guidance on rebalancing long-term services and supports.
Enhance conditions of participation for nursing homes and hospitals by including structural measures such as census and staff turnover.
Build out existing mechanisms like Care Compare to enhance public transparency, availability, and usability of cost report and ownership information and to provide timely and complete information on nursing facility citations.

Issue brief proposes local option for uninsured

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Examining the more than 3 million non-elderly poor adults in states without Medicaid expansion, the 红领巾瓜报 team of Matt Powers and former 红领巾瓜报 colleagues Nora Leibowitz and Jack Meyer, have authored an issue brief proposing a local health insurance option to fill gaps for these individuals who frequently lack access to meaningful healthcare.

The brief, , published by the , recognizes the critical role local entities and providers play in providing care and proposes a Local Choice Option, could:

Provide a comprehensive insurance product that promotes appropriate access to healthcare and better health outcomes
Repurpose funding now used only for direct care to provide healthcare more efficiently
Support local customization and create an alternative to an open-ended entitlement program in states where that is not currently politically tenable

The brief concludes a Local Choice Option would be a sound investment with the potential for quick implementation and benefits of health insurance not currently available to people living in poverty in non-expansion states.

Report examines the value of community behavioral health providers and their networks

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A recent report examines the importance of behavioral healthcare (BH) and its ability to improve outcomes and reduce costs when integrated in meaningful ways with medical services, especially primary care.

An 红领巾瓜报 team of behavioral health experts, including Annalisa Baker, Ann Filiault and Josh Rubin, published the report, with the New York State Council for Community Behavioral Healthcare and the New York State Collaborative BH Independent Provider Associations (IPA).

Patients with mental health and substance use disorders are heavy utilizers of healthcare services and Medicaid spending is nearly four times the cost compared to other enrollees. By developing and working within IPAs, providers can enable community healthcare and come together to establish systems of population care, build technology infrastructures, develop needed workforce and work toward value-based healthcare.

New York state is investing in the development of behavioral IPAs through the Behavioral Health Value Based Payment Readiness Program. The report outlines policy recommendations for promoting BH IPAs and maximize their positive impacts including:

Facilitate access to data for BH IPAs by enabling them to access the Medicaid Data.
Warehouse and including data sharing requirements in future managed care contracts.
Include BH IPAs in network adequacy definitions for Medicaid MCO Contracts to ensure that Medicaid beneficiaries have access to integrated behavioral health care and revise the definition of valid VBP Level 2 or 3 arrangements to include BH IPAs.
Fund a Phase 2 Infrastructure Program to provide the BH IPAs additional time to realize the goals of the BH VBP Readiness Program.

Second behavioral health issue brief focuses on workforce crisis and call for immediate action

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The (National Council) and 红领巾瓜报 have released the second in the series of three issue briefs examining the ongoing, and exacerbated, workforce and staffing crisis facing behavioral health services providers and facilities.

The brief, Immediate Policy Actions to Address the National Workforce Shortage and Improve Care, focuses on clinical transformation and provides short-term recommendations to support states in addressing the workforce shortages, provider burn-out, recruitment and retention.

Recommendations include:

Adopting transformative clinical approaches and team-based care
Identifying short-term actions and developing long-term strategies for improvement
Expanding the workforce to build a more robust provider pipeline
Increase adoption of in-person/telehealth hybrid models

红领巾瓜报 and the National Council colleagues contributed to the briefs and surrounding research.

红领巾瓜报 report compares quality outcomes across state Medicaid program delivery models

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A recently completed analysis of the impact of Medicaid managed care on key quality indicators found managed care organizations (MCO) outperformed fee-for-service (FFS) and primary care case management (PCCM) programs for both Child and Adult Core Set measures, once the data was normalized with respect to beneficiary distribution in each model.

The resulting听report听was in response to more states transitioning Medicaid beneficiaries from FFS to MCOs with a goal of reducing costs and improving quality. The 红领巾瓜报 team,听David Wedemeyer, Anthony Davis,听Sharon Silow-Carroll, and Joe Moser, used the 2019 Centers for Medicare & Medicaid Services (CMS) Core Set of Adult and Child metrics that cross the care continuum to develop a standardization model. The model aimed to classify quality outcomes on a state-by-state basis, based on the percent of members in direct FFS arrangements, MCOs, and PCCM programs.

The analysis suggested that performance differences could be attributed to the fact MCOs have structured care coordination and specialized programs, such as disease management, population health programs, and social determinants of health programs in place. As the 红领巾瓜报 team drilled down into sub-sections of the Core Set related to key domains such as preventive care, women鈥檚 health, disease management, and behavioral health, the findings were consistent in that MCOs tended to perform higher overall when compared to FFS and PCCM across all major domain categories.

In summary, 贬惭础鈥檚 findings suggest that the growth of Medicaid managed care plans has led to higher quality scores in several core areas of adult and child measures, lending support to the idea that managed care has had a positive impact overall on the quality of care for Medicaid members across the country. Additionally, 贬惭础鈥檚 review of the data and the team鈥檚 deep understanding of state oversight of managed care programs suggests that when a state strongly embraces a quality improvement framework as a long-term strategy and partners with its managed care plans on performance-based contracts, quality scores and outcomes may be stronger. The report also suggests that stronger state efforts to work with managed care plans to develop clear expectations and collaboration, while also leveraging MCOs鈥� access to clinical and quality data sources, may contribute to higher quality scores.

红领巾瓜报 experts evaluate differences between Medicare Advantage and Fee-For-Service Medicare responses to the challenges of the COVID-19 pandemic

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In a听new report听released by the Better Medicare Alliance听(BMA),听红领巾瓜报 colleagues Zach Gaumer and Elaine Henry听concluded that the greater flexibility of the Medicare Advantage plan model enabled plans to offer providers additional support during 2020听that听were not found within the听Fee-For-Service (FFS)听Medicare听program. The report鈥檚 findings were previewed in a recent panel discussion during the听BMA鈥檚听.听

National Council for Mental Wellbeing and 红领巾瓜报 have partnered to create a three-part series that examines behavioral health workforce crisis

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As demand for behavioral health services continues to grow, accelerated by the COVID-19 pandemic, staffing and workforce capacity to deliver services has not kept up with demand. In a three-part series of issue briefs, colleagues from 红领巾瓜报 (红领巾瓜报) and the (the National Council) offer immediate steps states can take to increase capacity and build a more stable workforce.

The first brief in the series focuses on Policy, Financial Strategies and Regulatory Waivers, and outlines solutions that can be implemented quickly to reduce administrative burden and maximize existing provider resources.

Several 红领巾瓜报 and the National Council colleagues, contributed to the briefs and surrounding research.

Study examines Austin LGBTQIA+ community, quality of life

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A new report summarizing the ShoutOut Austin Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual (LGBTQIA+) Quality of Life Study, has been released. The report summarizes research conducted by 红领巾瓜报 Community Strategies (红领巾瓜报CS) which included town hall meetings, surveys, stakeholder interviews, and focus group responses from a diverse group of community members.

Center for Medicare and Medicaid Innovation: Recommendations for Future Direction

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A recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous 红领巾瓜报 report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services鈥� (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.

The brief examines options for how CMMI could refine their approach to testing ideas for improving the Medicare program. 红领巾瓜报 colleagues Jennifer Podulka, Yamini Narayan, and Lynea Holmes wrote the brief which was supported by Arnold Ventures.

贬惭础鈥檚 earlier brief examined the progress the Innovation Center has made in learning from Medicare-focused models during its first decade and raised questions to guide policymakers as they plan for the next phase of the Innovation Center鈥檚 work. In the new report, the team returns to those questions and offers potential answers.

The brief outlines seven pairs of competing goals and offers four recommendations that may, in part, help to balance these competing goals, as they are designed to increase the transparency of Innovation Center efforts and improve the likelihood that more models succeed in decreasing spending or improving quality. The recommendations include:

The Department of Health and Human Services (HHS) should establish a National Healthcare Transformation Strategy
CMMI should articulate a vision for how different models work together
CMMI should tailor models to test ideas that address the largest areas of spending growth and key areas of quality concerns, including
- Include Part D in models
- Include Part C in models
- Promote primary care as a counterbalance to excessive low-value care
- Address social determinants of health and other drivers of quality and access disparities
Congress and HHS should revisit the Physician-Focused Payment Model Technical Advisory Committee (PTAC)

Strategic approaches to utilize ARPA funds to support older adults issue brief authored by 红领巾瓜报

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A new issue brief, authored by Madeline Shea and Aaron Tripp, provides an overview of key provisions of the American Rescue Plan Act (ARPA) of 2021 which offer the potential to make communities better places to grow older. ARPA provides an opportunity for states to build sustainable, person-centered systems and infrastructure for older Americans. These provisions aim to allow older Americans to age in their home and communities.

The provisions examined in the issue brief include addressing both long-standing and emerging needs of older adults for state government officials, including staff of Medicaid, aging, and housing and community development agencies; state legislators and their staff; and advisors to governors.

The ARPA funds are now available to states and local governments and will allow the development of better systems for older Americans. Key areas of opportunity outlined in the brief include

Building integrated data systems
Expanding affordable housing with services
Enhancing quality measurement and value-based purchasing models
Developing workforce recruitment and retention strategies
Ensuring access to internet services and assistive technology
Aligning Medicaid and Medicare services and payments
Creating ongoing structures to engage stakeholders in designing innovative and integrative approaches to meet community needs and monitoring their effectiveness over time

Case study examines Georgia鈥檚 experience unbundling LARC payments from Medicaid prospective payment system

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A new case study prepared by colleagues from 红领巾瓜报 (红领巾瓜报) analyzes the Georgia Medicaid program鈥檚 experience with unbundling long-acting, reversible contraception (LARC) devices and services from the Medicaid prospective payment system (PPS) for reimbursement in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

红领巾瓜报 examined Medicaid claims data from 2012-2019 as well as conducted key interviews to understand whether the unbundling reimbursement policy change could have increased LARC utilization and provided analysis for policymakers and stakeholders in other states pursuing similar strategies and programs.

Additional findings and the full report are available here.

贬惭础鈥檚 research was supported by and with support from . The 红领巾瓜报 team included Rebecca Kellenberg, Diana Rodin, and Jim McEvoy.

红领巾瓜报 colleagues conduct environmental scan of NEMT benefit to Medicaid enrollees

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As part of a larger Medicaid and CHIP Payment and Access Commission (MACPAC) study on Medicaid non-emergency medical transportation (NEMT) in response to a request from the Senate Appropriations Committee, a team of 红领巾瓜报 colleagues conducted a 50-state environmental scan of NEMT programs and stakeholder interviews to better understand approaches and trends in the provision of the NEMT benefit to Medicaid enrollees across the United States.

The culminating report included NEMT trends, challenges, and innovations drawn from the scan of programs and interviews with stakeholders including federal officials, Medicaid officials from six study states, NEMT brokers and providers, managed care companies, beneficiary advocates, and subject matter experts.

The key findings are outlined in the report and include information about:

NEMT populations and utilization
Various modes of transportation
NEMT delivery system model variations, advantages, and challenges
NEMT complaints, performance issues, and innovation
Performance improvement, oversight, and program integrity
Transportation network challenges and increasing role of transportation network companies
Coordination across federally assisted transportation services
Stakeholders鈥� view on the value and role of NEMT

In December 2020, following the completion of the interviews for this study, Congress added a requirement to the federal statute requiring states to provide NEMT to Medicaid beneficiaries who have no other means of transportation to medically necessary healthcare services.

The 红领巾瓜报 team included Principals Sharon Silow-Carroll, MSW, MBA and Kathy Gifford, JD, Senior Consultant Carrie Rosenzweig, MPP, Consultants Anh Pham and Julie George, JD as well as retired Managing Principal Kathy Ryland.

The research underlying this report was completed with support from the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed are those of the authors and do not necessarily represent those of MACPAC.

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81 Results found.