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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.
This week, our In Focus section reviews the release of the and pivots to the actions that Medicare Advantage Organizations (MAOs) could take to improve performance in future rating cycles.
Background
Newly MA Star Ratings information is based on the 2025 Star Ratings published on the Medicare Plan Finder on October 10, 2024. Star Ratings are largely based on the quality of care, member satisfaction, and retention.
The Centers for Medicare & Medicaid Services (CMS) increased many measure-level cut points from the 2024 Star Ratings, requiring MAOs to achieve higher performance on these measures to receive a four or higher Star Rating. An earlier In Focus reviewed a white paper published by Wakely, an 红领巾瓜报 Company, which provides an in-depth analysis of CMS鈥檚 latest policy and methodology changes that affect an MAO鈥檚 overall quality performance and Star Rating.
Topline Results
Significant attention is being given to the notable overall industry decline in Star Ratings. Specifically, only seven Medicare Advantage (MA) plans received an overall 5-Star Rating in 2025, compared with 38 in 2024. Only 40 percent of MA prescription drug plans achieved a score of four or five Stars versus 43 percent in 2024.
Key Considerations for Star Ratings, and What to Do About Them
The ratings significantly influence the financial and operational effectiveness of each MAO, directly affecting plan reimbursement and ability to enhance benefits. The 2025 Star Ratings will impact 2026 MA quality bonus payments. Health plans that earn four or more Stars are eligible for quality bonus payments and greater rebate percentage the following year. Plans may reinvest payments to make plan products more attractive to beneficiaries and emphasize a higher rating in their marketing efforts.
In the wake of CMS鈥檚 release of Star Ratings, an intense focus has shifted to each MAO鈥檚 specific overall Star Rating. Given the clear implications for population health and health plan sustainability, companies will need to quickly pivot to address opportunities for performance improvement. Key steps to optimize Star Ratings include:
Grow Foundational Knowledge聽鈥� MAOs need to build broad organizational understanding of the domains and measures, the weights, the levers that can affect individual measures and domains, and the rating cycle.聽
Assess the Current Landscape聽鈥� Organizations will benefit from having executive sponsorship, a governance structure, and overall leadership for each domain and measure. They should develop the ability to report on measures, and set interim goals. Assessments also need to ensure the network and bonus structure are aligned with Stars.聽
Develop a Roadmap聽鈥揂 calendar of events is critical for supporting performance improvement. This should include a preoperational and operational strategy as well as a year-over-year workplan to track, assess, and identify systems, technology, processes and people with a process for evaluation. Formulate a hiring and investment plan, if needed.聽
Prepare for Reporting and Oversight聽鈥� Develop a reporting and oversight structure, including a cadence of reporting and structure for review, process, and timing of reports by measure/domain leads. Ensure dashboards are updated annually to include new measures and weights and that a process is in place for managing display measures.聽
What to Watch
The MA landscape is highly dynamic, with some companies leading in market share, while others are leaders on quality ratings. As companies adapt to regulatory changes and strive for higher quality ratings, we can anticipate further shifts in the coming years. This will be exacerbated by shifts we are forecasting based upon the Health Equity Index and upcoming changes in Star weights. Strategies and actions MAOs implement in 2024 and 2025 will affect their 2026 Star Ratings.
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红领巾瓜报 experts have conducted in-depth analysis on all contracts, domains, and measures that roll into the Star Ratings. For further analysis of the 2025 trends and plan-specific impacts, contact Sarah Owens and Holly Michaels Fisher.
Explore The 红领巾瓜报 Stars Accelerator Solution for additional insights into programmatic strategies, best practices for design of meaningful solutions to implement, and approaches to measure the effectiveness of these solutions.
This week’s In Focus section previews key public policy issues affecting Medicare Advantage (MA) and Medicare Part D that could potentially be addressed under regulations issued by the Centers for Medicare & Medicaid Services (CMS) later this fall. CMS鈥檚 highly anticipated regulations鈥攚hich include annual programmatic, policy, and technical updates to the MA and Part D programs for the coming plan year鈥攁re under review at the Office of Management and Budget and are expected to be released in the coming weeks ahead.
In addition to the proposed rule, healthcare organizations are closely tracking CMS regulations that are expected to be released later this year, which would impact MA plan payment rates as well as proposed regulations intended to streamline the prior authorization process for prescription drug coverage under Medicare. This annual regulatory policymaking process is getting under way as the Medicare Open Enrollment period begins October 15, 2024, during which Medicare beneficiaries will compare Medicare health plan and drug coverage options and select the coverage that best meets their health care needs. (See Table 1 for key 2024 MA dates.)
As the last major Medicare policy regulations from the Biden Administration, healthcare entities can expect a continued focus on regulatory policies and requirements that strengthen program oversight and enhance beneficiary protections, while also seeking to maintain stability in Medicare benefits offerings and plan choices.
Following are some of the key issues to watch for as CMS鈥檚 annual regulatory process begins this fall.
Health Equity
Ensuring health equity is a foundational element of CMS鈥檚 strategic plan and the agency seeks to advance health equity goals and improvements across all of its programs, including Medicare Advantage. Beginning next year, MA plans will be required to conduct an annual review and analysis of utilization management (UM) policies and procedures from a health equity perspective. By requiring public reporting and identifying any impacts on underserved populations, this requirement is designed to ensure MA plans鈥� UM policies and procedures ensure access to medically necessary care, especially for vulnerable, low-income populations, such as beneficiaries who receive the Part D low-income subsidy and those who are dually eligible for Medicare and Medicaid.
In addition, CMS has finalized rules to collect health equity data, including race and ethnicity data, and adopted changes to the MA quality measurement program that will provide incentives for MA plans to improve care for underserved and vulnerable populations, including beneficiaries with high social risk factors.
Stakeholders should expect CMS to continue building and strengthening policies to advance health equity goals while exploring new initiatives to reduce disparities and close gaps in care for vulnerable populations.
Consumer Protection and Oversight
Earlier this year, CMS launched a high-profile effort to increase transparency in Medicare Advantage, including the release of a request for information (RFI) to solicit public input on ways to improve data collection and enhance oversight over all aspects of the MA program. Details are posted . In addition to seeking comments on improving overall MA data collection and public reporting, the CMS RFI on MA data collection solicited specific recommendations to improve data collection and accountability for MA plans鈥� provider networks and prior authorization process.
While the formal comment period closed in May 2024, responses to the CMS RFI on MA data collection can inform and shape future regulatory policy direction, as CMS continues to examine ways to improve transparency and oversight over MA plans.
Quality and Star Ratings
CMS will soon release the Medicare Advantage Star Ratings, which measure the quality of MA plans based on a range of quality and performance metrics. The Star Rating system provides beneficiaries with crucial information to compare plans and select the coverage option that best meets their needs. High-performing plans receive bonuses鈥攚hich provides incentives for plans to continue to improve quality of care for beneficiaries and patient outcomes. Last year, MA plans received $11.8 billion in bonus payments, and 74 percent of MA beneficiaries were enrolled in plans that achieved a rating of four or more stars. Details are available .
On the regulatory front, CMS recently adopted significant changes to Star Ratings that continue to have far-reaching impacts on MA plans鈥� quality performance, which, in turn, will continue to shape and inform their quality improvement strategies. Among the notable regulatory changes CMS has adopted is the new Health Equity Index, which rewards MA plans that provide high quality care to beneficiaries with social risk factors, including low-income beneficiaries and those dually eligible for Medicare and Medicaid. Though this policy change takes effect in 2027, MA plans can take steps now to prepare and enhance their capabilities to improve quality of care for beneficiaries with social risk factors, including using targeted care coordination programs.
As policymakers and stakeholders continue to monitor the impact of recently finalized changes to MA Star Ratings, CMS will continue exploring improvements to the MA Star Ratings system that further raise the bar on quality and ensure the program aligns with CMS鈥檚 broader goals and objectives.
Prior Authorization
As MA plans have increased the use of prior authorization and drawn scrutiny among patient advocates and providers, CMS has taken important steps to streamline and improve the prior authorization process to ensure timely access to care for Medicare beneficiaries. These regulatory policy changes鈥攚hich include continuity of care requirements beneficiaries, increased oversight over UM practices, and ensuing evidence-based clinical decisions within MA are consistent with traditional fee-for-service (FFS) Medicare鈥攁re intended to ensure prior authorization and other UM tools do not create barriers to medically necessary care for Medicare beneficiaries.
Policymakers continue to look for ways to further improve the prior authorization process, and CMS has additional interest in further regulatory standards to strengthen oversight and improve beneficiary protections. Potential policy options CMS could pursue include requiring more detailed reporting by MA plans (including number of prior authorization requests, denials, and appeals by type of service), extending prior authorization standards and consumer protections to prescription drugs covered by Medicare, and improving the timeliness of prior authorization decisions to avoid delays in necessary care.
Risk Adjustment Payment Policy and Coding
CMS has adopted significant changes to the MA risk-adjustment model, which continue to be phased in over a three-year period (2024鈭�2026). These changes include important technical changes to improve the model鈥檚 payment accuracy, including a focus on conditions that are subject to more coding variation. Because CMS risk-adjustment changes will be fully implemented by calendar year 2026, policymakers and stakeholders are closely monitoring whether CMS will pursue additional regulatory policies to improve the accuracy of the risk adjustment program and address coding issues.
Since 2018, CMS鈥攁s required by statute鈥攈as applied a coding intensity adjustment that reduces MA risk scores by 5.9 percent annually to ensure consistency with Medicare FFS coding. However, MedPAC and others have continued to that MA risk scores are higher than those for similar Medicare FFS beneficiaries, even after accounting for the 5.9 reduction in MA risk scores, which results in increased payments to MA plans. As policymakers continue to evaluate changes to ensure the long-term sustainability of the Medicare program, CMS could consider further changes in this area to equalize payments between MA and FFS Medicare through risk adjustment or coding changes.
Table 1. Key 2024 Medicare Advantage Dates
Date
Event
September 2024
CMS announces average premiums, benefits, and plan choices for MA and Medicare Part D for 2025.
Early-to-mid October 2024
CMS releases MA and Part D plan Star Ratings 2025.
October 15, 2024
Medicare Annual Election Period begins. Medicare beneficiaries can enroll in MA or Part D plans for CY 2025.
October or November 2024
CMS CY 2026 Policy and Technical Changes to MA and Medicare Part D (CMS-4208).
November 2024
CMS Interoperability Standards and Prior Authorization for Drugs (CMS-0062).
December 7, 2024
End of Annual Election Period.
Next Steps
The imminent release of CMS regulations come at a critical time for the Medicare Advantage program, which continues to experience enrollment growth amid a challenging and ever-changing regulatory environment. MA plans and other stakeholders need to be prepared to engage in the formal notice and comment process as well as offer policy solutions and best practices to strengthen and enhance the program for the 33 million beneficiaries it serves.
The 红领巾瓜报, Inc. (红领巾瓜报), team will continue to closely monitor the timing of the release of CMS regulations and will analyze the impact of the key provisions once these rules are released. We have the depth, experience, and subject matter expertise to assist organizations engaging in the rulemaking process and assessing their impact. 红领巾瓜报 can also assist with tailored analysis and modeling capabilities to assess the policy impacts across the multiple rules and guidance.
If you have any questions about the forthcoming CMS regulations and potential impact on MA plans, providers, and beneficiaries, contact Amy Bassano ([email protected]), Julie Faulhaber ([email protected]), Andrea Maresca ([email protected]), or Greg Gierer ([email protected]).
This week’s In Focus highlights a white paper that Wakely, a 红领巾瓜报, Inc. (红领巾瓜报), company published in September 2024, titled 鈥�.鈥� The paper provides an in-depth analysis of the latest cut point changes from the Centers for Medicare & Medicaid Services (CMS) to demonstrate how policies like the Tukey Outer Fence Outlier removal logic (Tukey), guardrails, and changes in overall quality performance have led to the highest Medicare Advantage (MA) Star Rating cut points in the program鈥檚 history.
Why Cut Points Matter
MA Star Ratings are a critical measure of the quality and performance of MA plans. The MA Star Ratings cut points are the thresholds CMS has set to evaluate the performance of MA plans. These ratings, ranging from 1 to 5 stars, are based on various quality measures, including clinical outcomes, patient experience, and plan administration. CMS applies methodologies such as Tukey to set the cut points and guardrails to stabilize them over time. MA plans are evaluated and earn a rating that is based on their performance against the cut points. Higher Star Ratings can lead to increased enrollment and higher payments from CMS, making them a key focus for MA organizations.
Key Findings
Wakely used the 2025 Star Rating Technical Notes to analyze measure-level cut point changes. The data summarize how Medicare Advantage organizations (MAOs) performed on various quality measures during the 2023 measurement year. Notably, the Tukey methodology was applied for the first time within the 2024 Star Ratings cut points. Initially, the full impact of this methodology was evident in the initial 2024 Star Ratings, but the updated 2024 Star Ratings restricted use of guardrails and spread the impact of Tukey over a few years.
The analysis reinforces expectations for changes in MA spending in 2026, in part because of changes in Medicare Advantage Prescription Drug Overall Star Ratings.
鈥�, Wakely
Key Considerations
The Star Ratings have been on a steady decline over the last two years while CMS continues to refine and evolve its Star Ratings methodology and areas of focus. Key issues to consider in this climate include:
MAOs are experiencing significant reductions in quality bonus and rebate payments, which potentially affects opportunities to improve member health outcomes.
Strategies to enhance Star Ratings and elevate program quality are crucial for performance and meeting the unique needs of MA enrollees.
MA plans and other stakeholders also should consider that as plans optimize performance on certain traditional quality measures, CMS is placing increased emphasis on member experience with their health plan and providers during care.
The Star Ratings is an important tool CMS uses to redirect plan focus and resources.
CMS is scheduled to release the final scores and Star Ratings for Star Year 2025 in early October 2024. These ratings will be based on the performance data from the 2023 dates of service. This release will provide MAOs with updated quality and performance metrics, which are used to determine CMS Star Ratings and subsequent quality-based payments.
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For further insights into the Star Ratings and more information on the report, contact report authors Suzanna-Grace Tritt, ([email protected]), or Lisa Winters, ([email protected]).
Strategies and actions MAOs implement in 2024 and 2025 will affect their 2026 Star Ratings. For further insights into programmatic strategies, best practices for design of meaningful solutions to implement, and approaches to measure the effectiveness of these solutions, explore The 红领巾瓜报 Stars Accelerator Solution.
This week, our In Focus聽section from the 红领巾瓜报 Weekly Roundup highlights the Illinois Department of Healthcare and Family Services聽聽(RFP) for a dual-eligible special needs plan (D-SNP) to replace its current Medicare-Medicaid Alignment Initiative (MMAI) demonstration.
Overview
Illinois is one of the states affected by the Centers for Medicare & Medicaid Services (CMS) decision to end the capitated model in the federal Financial Alignment Initiative (FAI) demonstration. Illinois is among the last states to issue an RFP that will support the transition from the demonstration program. Two states, Texas and South Carolina, have yet to issue RFPs. On September 10, 2024, CMS issued a discussing end-of-demonstration enrollment and operational considerations and deadlines by which states should make operational decisions.
The 红领巾瓜报, Inc., (红领巾瓜报) In Focus article June 26, 2024, discussed related changes that CMS finalized to the federal policy framework for D-SNPs to enhance care coordination, improve health outcomes, and ensure that dual-eligible beneficiaries receive accurate information about their healthcare while integrating successful features of the FAI demonstration and the Medicare-Medicaid Plan (MMP) program. These decisions are prompting more states to develop new models for integrating Medicare and Medicaid services.
Illinois D-SNP RFP Highlights
This Illinois procurement will transition the state to a fully integrated dual-eligible special needs plan (FIDE-SNP) model, which will include a requirement that plans provide managed long-term services and supports (MLTSS) for both people who are dually eligible and Medicaid-only beneficiaries beginning in 2027.
The RFP is largely focused on quality care provisions and improved care coordination across all services lines, including overall expectations to achieve the following:
Improved access and quality of community-based behavioral health services
Better quality of care in facilities
Fewer program opt-outs
A strategy for increasing the use of alternative payment models (APMs) in Medicaid managed care in Illinois, particularly for behavioral health providers
Emerging National Trends
Overall, the Illinois D-SNP procurement reflects broader national trends toward more coordinated, equitable, and outcome-focused healthcare.
Focus on Health Equity. The procurement emphasizes health equity and reducing disparities, including information on innovations that are responsive to health-related social needs (HRSNs) and social determinants of health (SDOH). The state is weighing payers鈥� experience partnering with non-traditional providers to meet Medicaid customers鈥� needs, their innovative programs to address customers who are difficult to locate, and their strategies for improving care for adults with complex needs in facility or community-based settings.
In addition, the state will require plans to report outcomes by race, ethnicity, and geography. Given the demographic and health equity reporting requirements, payers should be prepared to speak to their data collection, member engagement strategies, and relationships with community-based organizations. This capability will be an essential component of addressing both population health and health equity activities.
Alternative Payment Models. The RFP also requests detailed information on the payer鈥檚 strategy for increasing the use of APMs in Illinois Medicaid managed care, including the models the payer intends to implement. Experience supported by data-driven outcomes and explanations of work with providers or clinics to adopt, manage, and support reporting and analytics for APMs is a key area of interest for the state. Notably, the state seeks information on plans to include behavioral health providers in APMs.
Long-Term Services Related Transitions. The RFP questions also reflect the long-term services and supports that dually eligible beneficiaries need, as well as those of Medicaid-only beneficiaries who are eligible for these services. More specifically, the RFP raises questions to determine how payers will effectively implement nursing home diversion plans, incentivize hospitals to discharge patients to community settings, and approaches to transition members from institutional settings to the home and community, including by connecting members with supports for HRSNs. Payers will be expected to provide specific examples of their experience and outcomes in other states.
Emerging National Trends
The emphasis on health equity in the Illinois RFP reflects a broader national trend. States are increasingly interested in鈥攁nd in some situations required鈥攁ddressing SDOH and reduce disparities, especially for the Medicare and Medicaid dual-eligible population. As a result, payers and other healthcare organizations must develop capacity internally and through external collaborations to build their expertise and evidence base for advancing improvements.
The push for APMs in the Illinois procurement aligns with national efforts to move away from fee-for-service models. Illinois鈥檚 inclusion of behavioral health providers in APMs and requiring integrated care models highlights the growing recognition of the importance of mental health in overall health outcomes.
Illinois鈥檚 RFP also reflects heightened interest in improving care transitions and coordination. The potential for incentive programs related to community placement and increased focus on nursing home diversion will require innovative plans and a long-term commitment to working with all stakeholders to build on the federal FAI experiences.
What We鈥檙e Watching
Responses to the Illinois RFP are due October 18, 2024, and awards are expected to be announced in December. The state anticipates making awards to the top four bidders. Contract execution is estimated July 2025, with implementation January 1, 2026.
As the FAI demonstration ends and CMS鈥檚 integration requirements take effect over the next several years, there will be a steep learning curve for states, payers, and other key stakeholders adapting to this evolving environment. Compliance with new CMS rules will be crucial, and experiences in Illinois and other FAI demonstration states can provide valuable insights for other states and stakeholders.
Additional growth and program refinements in the federal Medicare Advantage (MA) landscape are expected in the coming years, especially among MA D-SNPs. Those MA D-SNPs that have yet to participate in Medicaid will need to continue make significant business decisions on participation and actively compete to secure state Medicaid contracts, which will have downstream implications for their state and local partners.
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红领巾瓜报 (红领巾瓜报) experts continue to review the evolving landscape and federal changes that will affect D-SNPs in 2025 and beyond. Contact 红领巾瓜报 experts Julie Faulhaber, Holly Michaels Fischer, Greg Gierer, Dara Smith, and for details about the nationwide D-SNP rules and landscape.
The upcoming 红领巾瓜报 event, , offers extensive opportunities to engage with leaders from various sectors who are designing and implementing Medicare-Medicaid integration initiatives. Join us for main stage panel discussions with distinguished health plan executives from national and local plans and Medicaid directors from Iowa, New Mexico, New York, and Rhode Island.
红领巾瓜报 Principal Holly Michaels Fisher will lead a deeper dive into integration issues during the breakout session, Innovations to Improve Outcomes for Medicare-Medicaid Dually Eligible Individuals, with speakers , President and CEO of WellCare; , Medical Director for the Division of Aging at Indiana Family and Social Services Administration; , Executive Medical Director for the Center of Excellence of Medicare Duals/D-SNP at Aetna; and , Deputy Secretary for the Office of Long-term Living in the Pennsylvania Department of Human Services.
During the breakout, Meeting New Expectations for Health Equity and Improved Beneficiary Outcomes in Medicare Advantage, 红领巾瓜报 Principal Greg Gierer, will facilitate a conversation on the evolving landscape of MA rates and supplemental benefits, with experts , Health Economist and Bloomberg Distinguished Professor at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Carey Business School; , Director of the University of Michigan鈥檚 Center for Value-Based Insurance Design, and , Vice President of Policy and Government Affairs at the SCAN Group.
In recognition of this September, our In Focus section spotlights a new report from 红领巾瓜报, Inc. (红领巾瓜报), Substance Use Disorder in California: A Focused Landscape Analysis. Published in August 2024 with support from the California Health Care Foundation, this analysis provides valuable insights into California鈥檚 substance use disorder (SUD) treatment system and offers actionable recommendations for improvement that can be applicable for other states.
The SUD Landscape in California
SUDs continue to be a significant issue both nationally and in California. In 2022, approximately 9 percent of Californians ages 12 and older met the criteria for SUD, compared with 16.5 percent nationally in 2021. The prevalence of SUD is also on the rise: in 2015, 8.1 percent of Californians ages 12 and older met SUD criteria, rising to 8.8 percent in 2022. Of the Californians struggling with SUD, only 10 percent received treatment for their condition, compared with 6 percent nationally in 2021. Overall, 81 percent of US adults who received care for SUD reported struggling to access necessary services.
California鈥檚 public behavioral health system siloes specialty mental health (MH) services, mild-to-moderate MH services, and SUD treatment services, resulting in a fragmented and inconsistent system that struggles to effectively support people with co-occurring conditions.
County plans administer specialty behavioral health (BH) services. They all have memorandums of understanding with the state鈥檚 Department of Health Care Services that are separate from the state arrangements to provide physical healthcare services. BH programs vary significantly across the state because counties operate them differently, with key variations in access policies, quality monitoring, services, and programming. Mild-to-moderate (non-specialty) MH benefits are administered by Medicaid managed care plans. Much of the state鈥檚 SUD treatment is operated by the Drug Medi-Cal Organized Delivery System (DMC-ODS).
Barriers to Care: Key Findings
System barriers prevent many Californians with SUD from accessing adequate care. Interviewees received a pre-interview questionnaire to determine the factors they believe have the greatest impact on access to SUD treatment. According to 11 out of 14 respondents, lack of access to housing and residential services is a 鈥渉uge barrier鈥� to SUD treatment.
Other barriers to care access, ranked in order, include limited access to food, transportation, and other social drivers of health (SDOH), SUD provider shortages, stigma against people with SUD, disparities in service availability across racial/ethnic groups and other populations, and complex referral and intake processes.
Respondents also identified factors that could negatively affect clinical outcomes for people with SUD. Insufficient access to stable housing ranked first, followed by inadequate care coordination, and limited access to residential SUD treatment. Respondents ranked 11 factors as follows:
Figure 1: Factors Leading to Reduced Outcomes, Ranked from a List of 11
Service gaps pose another significant barrier to people accessing SUD treatment, and some populations are more likely to encounter challenges than others. According to the respondents, by various population groups, Latine/Hispanic populations, African American/Black populations, and Native American/Alaska Native populations are most likely to experience SUD service gaps. By age, people who are 19鈭�25 years old (transition-age youth) and adults ages 26鈭�65 are most likely to face service gaps.
Opportunities to Support Improvements in SUD Care
Findings and recommendations to enhance support for individuals are informed by surveys and interviews conducted with SUD stakeholders from across the state. Recommendations highlighted in the report include:
Investments in the workforce.聽By addressing the shortage of licensed clinicians and implementing peer support workers into the care continuum, the state would increase access to care. Many stakeholders have positioned themselves to meet SUD needs, but they cannot do so without an adequate workforce. Furthermore, the workforce would benefit from strengthening culturally responsive training in evidence-based practices.
Expansion of residential treatment services and housing options. There is a growing need, especially among transition-age youth, for residential treatment and SUD recovery housing.
Increased access to and training around harm reduction. Although stigma around harm reduction has decreased, training and access remains a barrier. Respondents highlighted the need to better manage contingencies, make methadone more accessible, establish safe consumption sites, expand medication assisted treatment for SUD and AUD, and improve the availability of Narcan.
MH and SUD treatment integration.聽Offering concurrent MH and SUD treatment with the same providers can help improve access to care for people with co-occurring conditions and minimize duplication.
Improved care coordination.聽Respondents suggested funding formal care coordination positions鈥攁 recommendation that is consistent with the national movement toward the coordinated care model applied in certified community behavioral health centers.
Improved data literacy.聽Behavioral health organizations need support and technical assistance to learn how to track and use data to support continuous quality improvement.
What to Watch
The overarching challenges facing California鈥檚 recovery system are present in other states. These states can adapt the strategies discussed in this report to address their own SUD concerns. In California, as in other states, an important aspect of addressing SUD treatment involves strategic allocation of opioid settlement dollars. These funds, resulting from legal settlements with opioid manufacturers and distributors, are expected to play a significant role in improving the state鈥檚 SUD treatment infrastructure, especially when considered alongside available federal funding, demonstrations, and regulatory flexibilities.
Connect With Us
The upcoming 红领巾瓜报 event, , will offer more opportunities to engage with leaders from various sectors who are advancing solutions to improve access to care and reducing access disparities. Throughout the conference, federal and state officials, community leaders, and national experts will shed light on the challenges and solutions to these issues.
This week鈥檚 second In Focus continues the conversation on drug policies and trends, providing updates and insights into the current landscape of Medicare’s drug price negotiations.
The Centers for Medicare & Medicaid Services (CMS) recently released the negotiated prices for the first 10 Medicare Part D drugs under the Inflation Reduction Act鈥檚 (IRA鈥檚) negotiation authority. CMS plans to add more drugs to the negotiation list, including 15 additional Part D drugs in 2027 and 15 more products from both Part D (pharmacy benefit drugs) and Part B (mostly physician administered drugs). In 2029 and later years, another 20 drugs from either Part B or Part D will be chosen.
Negotiated Prices for First 10 Drugs Leave Unanswered Questions
CMS estimates the negotiated prices for 30-day supplies of each medication will result in savings ranging from 38 percent to 79 percent compared with list prices when they take effect in 2026. This comparison, however, does not account for several factors that could affect the actual savings for the Medicare program and beneficiaries, including:
Current negotiated discounts available to Medicare Part D plans
Changes in tier placement for the negotiated drugs and their impact on patient cost sharing
The exemption for manufacturers from the 10 percent discount during the initial coverage phase and the 20 percent discount thereafter once negotiated prices take effect in 2026
The effect of Medicare鈥檚 negotiations on prices paid by other payers
The impact of the IRA program on prices for other products and manufacturer investments in research and development of new products
CMS is required to provide a detailed explanation of how negotiated prices were determined by March 1. The price comparisons with privately negotiated prices, however, will remain unclear and the effects on other payers and longer-term investments in new products may not be fully understood for some time. The table below lists the negotiated discounts for the first 10 drugs, which CMS selected from the top 50 Part D drugs by spending, which lacked generic or biosimilar alternatives and met other IRA criteria.
Negotiated Drug Prices Applicable in 2026
Source: CMS – .August 2024.
Looking Ahead
Age of Products and Role of Generic and Biosimilar Competition: Drugs eligible for negotiation are typically the highest expenditure drugs that have been on the market for at least seven years or 11 years in the case of biologics. Importantly, products with generic or biosimilar competition are exempt from negotiation. This exemption may increase the speed at which biosimilar or generic competition comes to market, as the IRA requires competitors to engage in bona fide marketing to exempt an innovator from negotiation. Despite approval, biosimilars for some of the drugs will remain subject to negotiated prices until their marketing efforts begin.1
Impact on Medicaid and Other Payers: The IRA鈥檚 negotiated discounts are not required to be available outside of the Medicare program. It remains uncertain whether other payers will use Medicare-negotiated prices as leverage in their own negotiations. For Medicaid, the direct impact of negotiations themselves is expected to be negligible; however, the IRA鈥檚 inflation penalties could encourage more manufacturers to moderate price increases over time, potentially leading to reduced inflation penalty rebates to state Medicaid programs.
Connect with Us
To explore these topics further, join 红领巾瓜报 at the upcoming event,鈥�. Engage with Medicare experts such as Kevin Kirby and Amy Bassano. Kevin will lead a small group discussion on trends in prescription drug policies during the pre-conference workshop.
For details on IRA pricing issues or other Medicare health policy developments, contact Mr. Kirby, Mark Desmarais, or Ms. Bassano. 红领巾瓜报鈥檚 Wakely Actuaries also are available to discuss the IRA鈥檚 role in Medicare Part D.
The report, released in August 2024 with support from Arnold Ventures, includes survey responses from 47 states (including DC) for state fiscal years (SFYs) 2023 and 2024. The survey instrument builds on questions posed in the of all 50 states and the District of Columbia, which 红领巾瓜报 and the Kaiser Family Foundation conducted.
The report discusses state trends for how Medicaid pharmacy benefits are administered across the country, including planned priorities and anticipated challenges in SFY 2025 and beyond. The findings are based on information provided by the nation鈥檚 state Medicaid Directors, Medicaid Pharmacy Directors, and other Medicaid agency experts.
Pharmacy Benefit Administration
In many states, managed care delivery systems play a pivotal role in administering Medicaid benefits, including prescription drugs. As of July 1, 2023, survey results found that:
A total of 33 states carved pharmacy benefits into managed care organization (MCO) contracts, with one state, Kentucky, directing its MCOs to use a single state-selected pharmacy benefit manager (PBM).
Eight states carve-out the pharmacy benefit鈥攄ouble the number in 2019.
MCO states were surveyed about their use of carve outs for certain drug products/classes, inclusive of physician-administered drugs covered under the medical benefit.
In all, 19 states reported carving out one or more drug classes or select agents within a drug class鈥攐ften high-cost specialty drugs.
Of those states, 13 reported using the carve-out as part of a risk mitigation strategy.
Pharmacy Benefit Managers
The significant role and market power of PBMs have prompted many state legislatures to enact greater transparency practices and require health plans to accept more responsibility for monitoring the PBMs they contract with, which reflect notable changes since the 2019 survey. More specifically:
A total of 33 states reported contracting with a PBM.
The most frequently reported PBM functions included utilization management, drug utilization review, claims processing and/or payment, and rebate administration activities.
The 30 MCO states that carve in pharmacy benefits responded to survey questions about PBM transparency and spread pricing requirements. Of these states:
25 prohibit spread pricing in MCO PBM contracts鈥攎ore than double the number of states reporting prohibitions on spread pricing in 2019.
17 reported having PBM transparency reporting requirements.
10 states reported having 鈥渁ny willing鈥� pharmacy requirements.
The Role of PDLs, Prior Authorization, and Step Therapy in Controlling Drug Costs and Utilization
红领巾瓜报鈥檚 experts also sought information on state payment strategies and utilization management protocols that are used to manage pharmacy expenditures. Nearly all responding states (44) have a preferred drug list (PDL) in place for fee-for-service prescriptions, which allow states to drive the use of lower cost drugs by encouraging providers to prescribe preferred drugs. Further, nearly two-thirds of responding MCO states (19 of 30 states) that do not carve out the pharmacy benefit reported having a uniform PDL for some or all drug classes, requiring all MCOs to cover the same drugs.
Many states鈥痟ave implemented鈥痵tep therapy鈥痑nd prior authorization (PA) guardrails in their Medicaid programs through legislation. However, 85.1 percent of responding states (40 of 47) report utilization controls like PA or step therapy applied to drugs that are reimbursed through the medical benefit to control utilization and costs. States also play an active role in managing MCO clinical protocols or medical necessity criteria, with 22 out of 30 MCO pharmacy carve-in states reporting that they require uniform clinical protocols for some or all drugs with clinical criteria. Approximately one-half of responding MCO carve-in states also require review and approval of MCOs鈥� PA criteria (15 of 30 states) and step therapy criteria (14 of 30 states).
State Adoption of VBAs: Improving Patient Access to Cell and Gene Therapies
A growing number of states are actively considering entering into value-based arrangements (VBAs) with manufacturers, as pressure to improve patient access to cell and gene therapies increases. Nine states have at least one VBA in place, and 23 states reported that VBAs are among their future solutions for addressing coverage of new high-cost therapies. States will need to address common barriers to VBA implementation, which involves more upfront costs and operational challenges to implement than traditional contracts.
Subsequent to the submission of survey responses, the Centers for Medicare & Medicaid Services (CMS) released a Cell and Gene Therapy (CGT) Access Model, which begins with a focus on sickle cell disease, anticipated to go live on January 1, 2025. Under the model, CMS will negotiate outcomes-based agreements with manufacturers on behalf of the state to ensure that treatment pricing is related to treatment effectiveness. In the coming years, experiences with this model will help determine whether a CMS-led approach to developing and administering VBAs for CGTs improves Medicaid member access to innovative treatment and their impact on expenditures, if any.
Source:
Looking Ahead
Managing the Medicaid pharmacy benefit has never been more challenging. In FY 2025 and beyond, most states will be focused on managing their Medicaid pharmacy budgets, especially the development of VBAs and other policies and strategies for managing new high-cost therapies. Other top priorities and challenges cited by multiple states include management of PBM arrangements and considering coverage of the new generation of GLP-1 anti-obesity medications. States also must react to changing drug marketplace conditions driven, in part, by federal policy changes to the Medicaid drug rebate formula and changes designed to lower Medicare drug costs. Drug manufacturer responses to these changes have implications for Medicaid state budgets, but also for state PDL management decisions and beneficiary access to needed medications.
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The upcoming event,鈥�, hosted by 红领巾瓜报, will offer more opportunities to engage with report author Kathy Gifford at the pre-conference workshop Paying for Innovative Pharmaceuticals: State and Federal Trends Shaping Public Programs. Leaders from various sectors will join Kathy to discuss trends in prescription drug policies in public and commercial insurance programs.
红领巾瓜报 works with managed care plans to maximize Star ratings and improve program quality.
Star Ratings have been on a steady decline over the last two years resulting in large reductions in quality bonus and rebate payments, potentially impacting opportunities to improve member health outcomes.
How 红领巾瓜报 can help improve a plan鈥檚 Star rating:
We have developed a playbook that captures The 红领巾瓜报 Stars Accelerator Solution with proven strategies for Stars improvement based on our diverse and extensive expertise in managed care plan (MCP) operations, MCP strategy, performance improvement, actuarial science, data analytics, risk adjustment, and federal and state policy.
Using our vast experience in the Medicare and Medicaid space, 红领巾瓜报 can help you maximize ratings in programs like Medicare Stars and Medicaid quality performance. Together with our actuarial colleagues from Wakely Consulting Group and federal policy expert colleagues from Leavitt Partners, both 红领巾瓜报 companies, we can provide the assistance you need to move your organization to a higher Star rating level. With guidance from 红领巾瓜报 experts, the Accelerator is scalable for both functional and matrix organizations.
红领巾瓜报 can help your organization create momentum by combining 红领巾瓜报鈥檚 programmatic strategies with a robust actuarial and analytical basis, inclusive of integrated risk adjustment. Meaningful data analysis ensures plans can prioritize the most important areas for strategic focus. Improving performance in Stars requires a multi-pronged, multifactorial approach. The 红领巾瓜报 Stars Accelerator Solution is consumer-oriented and customizable to meet the unique needs of your members鈥� needs. It facilitates understanding of the organization鈥檚 current state, identifies opportunities for improvement, provides best practices for design of meaningful solutions to implement, and measures the effectiveness of improvements.
Why is a high Star rating important for a health plan?
The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). Star ratings impact a managed care plan鈥檚 financial performance, competitiveness, growth, and member retention. They are based on measures of multiple aspects of plan performance including:
Member experience and satisfaction
Administrative performance
Medication safety and/or adherence
Hospital readmissions
Healthcare Effectiveness Data and Information Set (HEDIS) and Health Outcomes Survey (HOS) both of which measure performance improvement.
Contracts are rated on a scale of one to five stars (rounded to nearest half star) based on approximately 45 measures related to preventive care, member experience (health plan customer service, physician point of service care, and perceived health), prescription drug monitoring, health plan operations, etc.
The industry has meaningfully improved traditional quality metrics (e.g. preventative care and medication adherence rates). As performance peaks in those measures, CMS is placing increasing emphasis on the member experience with their health plan and their providers during care.
Plans with 5 stars can market year-round.
The marketing advantage is a distinction for a high rated plan.
Poor performers (under 3 Star rating for 3 years) receive a Poor Performance Icon and may not be able to renew with CMS.
In 2024 there were 29 Part C (Medicare Parts A & B) and 11 Part D (Pharmacy) measures, and they can change every year. CMS recently released plan preview Star performance data for health plans to review. Final scores and Star ratings will be released by CMS in early October 2024 for Star Year 2025 based upon 2023 dates of service.
Star Rating High Level Timeline
CMS Star Ratings are a lagged pay-for-performance system. For 2026 Star Ratings, 2024 and early 2025 performance timeframes are critical to success, even though payments for this performance will not be received until 2027.
What plans do in 2024 and 2025 impacts your 2026 Star rating which will affect your plan鈥檚 revenues in 2027.
Is your plan building a strategy for next year based upon underperforming measures? Are you looking for ways to lean in on any remaining Consumer Assessment of Healthcare Providers and Systems (CAHPS) and HOS opportunities? Do you know where to start?
This week, our In Focus section reviews state policies designed to increase insurer participation in Medicaid managed care and Marketplace programs. As states seek to address healthcare costs, affordability, and consumer experiences, they are exploring a range of initiatives鈥攆rom the rise of prescription drug affordability boards to cost containment commissions, cost growth benchmarks, transparency, and examination of mergers and acquisitions.
A notable trend is the use of state policy and purchasing power to encourage or mandate that Medicaid managed care organizations (MCOs) offer Marketplace plans. Dual-market participation can help smooth coverage transitions, ensure continuity of care, and expand consumer choice. The remainder of this article addresses original research and analysis of this trend by 红领巾瓜报, Inc. (红领巾瓜报), experts Zach Sherman, Aimee Lashbrook, and Hannah Turner.
Current Landscape
In 2024, enrollment in the Marketplace program has surged to more than 21 million, approximately a 30 percent increase from 2023. This growth was largely attributed to the temporary enhanced subsidies that allowed more people to access affordable coverage. Over the past several regulatory cycles, federal policymakers also have taken steps to further align the Marketplace framework with Medicaid on key issues, such as essential community provider access, eligibility and enrollment processes, and plan design standards. In response, states are innovating to meet federal requirements while pursuing their own healthcare goals related to coverage, affordability, access, and healthcare outcomes.鈥�
Value Proposition
A compelling value proposition for Medicaid MCOs to participate in the Marketplace (and vice versa) includes the ability to market to and retain people moving from one program to another as life circumstances change. Dual-market participation also supports diversification and growth strategies. In fact, enrollment in the Marketplace has nearly doubled since 2020. For Medicaid MCOs in particular, expanding product offerings to include Marketplace plans presents a unique opportunity to leverage existing provider networks and reimbursement arrangements to deliver more competitive rates.
Consumers benefit when the same organization participates in both markets. Families with parents and children who obtain coverage under different programs have an opportunity to work with a single organization and choose providers from the same or overlapping networks. Income fluctuations may result in disenrollment from one program (e.g., Medicaid) and eligibility for a new program (e.g., Marketplace subsidies). Continuity of care policies can smooth these transitions in areas such as prior authorization, care management, and provider network.
State Strategies to Increase Dual-Market Participation
The Affordable Care Act expanded access to affordable health insurance coverage for as many as 45 million individuals by giving states the option to expand Medicaid and provide federal subsidies to people who purchase Marketplace plans. States are now using various strategies to encourage or require insurer participation in both programs to ease transitions for individuals and families 鈥渃hurning鈥� from one program to another, increase competition and choice of Marketplace plans, and reduce the risk of coverage gaps. For example:
Nevada聽is requiring any bidder that plans to respond to its upcoming Medicaid MCO procurement to separately submit a 鈥済ood faith鈥� response to the聽. This state-contracted, public option will be available on the Silver State Health Insurance Exchange beginning in 2026. Failure to submit a good faith proposal will disqualify an organization from participating in the Medicaid MCO procurement later this fall. Nevada鈥檚 current Medicaid MCOs must participate in the Marketplace by offering at least one Silver and one Gold qualified health plan (QHP) that has overlapping provider networks, serves the same service area, and charges reasonable premiums.聽
Rhode Island听补苍诲听New Mexico聽require or intend to require that their Medicaid MCOs participate in the Marketplace. As an awardee of Rhode Island鈥檚 recent Medicaid MCO procurement, UnitedHealthcare, must reenter the HealthSource Rhode Island market in 2027. These states also have designed their Medicaid MCO auto-assignment methodology to favor enrollment in a Medicaid MCO affiliated with an individual鈥檚 previous Marketplace plan or a family member鈥檚 Marketplace plan.聽聽
In its last Medicaid MCO procurement (2018),聽North Carolina聽offered bonus points to any bidder that agrees to offer a Marketplace MCO. The resulting contract codified the market entry commitment and included implications for failure to follow through. Nonfulfillment could result in the highest level of contract noncompliance and associated penalties.聽
础谤办补苍蝉补蝉听expanded its Medicaid program using federal matching funds to purchase QHP coverage through the Marketplace.聽Minnesota, one of the few states offering a basic health program, contracts with the same organizations to provide coverage under both programs.聽聽
Iowa聽uses contract language to encourage, but not require, Medicaid MCOs to participate in the Marketplace to facilitate continuity of care during coverage transitions.聽
The Centers for Medicaid & Medicare Services (CMS) collaborated with states to promote continuity of coverage following the end of the Medicaid continuous enrollment requirement established in the Families First Coronavirus Response Act of 2020, also known as the Medicaid public health emergency (PHE) unwinding. This support includes the of permissible outreach activities by Medicaid MCOs that also offer a Marketplace plan, information sharing, and other assistance. Many states have incorporated the CMS guidanceiii into Medicaid MCO contracts. North Carolina, Utah, and West Virginia include additional contract terms supporting their Medicaid MCOs鈥� ability to co-market Medicaid and Marketplace plans, including when an individual is losing Medicaid eligibility.
What to Watch For
Coverage transition challenges throughout the Medicaid PHE unwinding have highlighted the real-life impact of coverage gaps and the importance of policies and practices that promote uninterrupted access to healthcare coverage. Historic Marketplace enrollment levels and recent CMS guidance clarifying the allowability of outreach to people who are losing Medicaid coverage about Marketplace plan available make the prospect of dual-market participation increasingly attractive for Medicaid MCOs. A greater focus on improving continuity of care and Marketplace plan choice may lead to more states encouraging or requiring Medicaid MCOs to participate in the Marketplace.
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The upcoming 红领巾瓜报 event,鈥�, will offer more opportunities to engage with leaders from various sectors who are advancing innovations in Medicaid managed care and Marketplace programs and the points at which these programs intersect. State Medicaid and insurance commissioners, health plan executives, and community leaders, among others, will share insights into their market success and initiatives designed to address healthcare costs and insurance affordability.
Experts from 红领巾瓜报 and our family of companies have extensive experience in the policy, structure, and administration of healthcare markets and health plan contracting. For more information, contact 鈥�Zach Sherman.
This week, our聽In Focus聽section recognizes聽聽(IOAD), August 31, by highlighting how states can use opioid abatement funds to mitigate the persistent overdose crisis in communities across the country.聽聽
In honor of IOAD, the August 2024 edition of 红领巾瓜报鈥檚 Podcast, Vital Viewpoints, features Erin Russell, a Principal at 红领巾瓜报 (红领巾瓜报), who discusses the importance of emphasizing harm reduction as a compassionate approach to drug policy. Meanwhile, this article addresses current gaps, opportunities, and strategies for applying opioid abatement funds to make further progress in addressing overdoses and the crisis.
Context for Opioid Abatement
Overdoses have more than one million lives since the late 1990s, with more than 100,000 deaths occurring annually. Exacerbating the overdose epidemic and the racial and ethnic disparities in fatal overdoses are persistent inequities in access to evidence-based treatment, which extend to biases based on physical and/or mental ability, sexual orientation and gender identity, geographic location, and socioeconomic and housing status.
In 2021, nationwide settlements were awarded to resolve all opioid litigation that states and local subdivisions brought against pharmaceutical distributors and manufacturers, with subsequent agreements reached in 2022 against pharmacy chains and additional manufacturers. These historic opioid settlement agreements, which total more than $56 billion, will provide funds to state and local governments to address the crisis in their communities.
Policy changes and investments to address this epidemic remain critical. These approaches require careful consideration of the data and evidence-based strategies that are responsive to the crisis. In 2024, the US Department of Health and Human Services issued a that updates the regulations regarding the governance of opioid treatment programs; for example, removing barriers to the treatment of substance use disorder (SUD) and expanding access to care. The and grant programs are another significant tool to improve prevention, expand treatment, and deliver free, lifesaving medications. Medicaid, including Medicaid managed care plans, also can be instrumental in supporting harm reduction strategies and enhancing access to addiction treatment and recovery support.
Opioid abatement funds offer states the opportunity to apply innovative solutions in response to the overdose epidemic. Despite their potential, however, 红领巾瓜报 experts have identified significant opportunities across many states to effectively use available opioid abatement funds.
Opioid Abatement Funds and planning for Community Needs
Strategic planning processes allow state and community leaders to understand the needs of residents, examine current services offered and their existing strengths, and explore barriers to accessing care to make informed decisions about how the settlement funding can be used successfully. A strategic plan can assist in tracking progress and establishing a clear vision for an organization鈥檚 future and can yield a living document that guides the most advantageous use of the funds. 红领巾瓜报 experts supported a strategic planning process for , NC, that identified strategies for designing, implementing, and evaluating tailored solutions for disbursing opioid abatement funds. The following are examples of approaches that are included in strategic plans for opioid abatement.
Sequential intercept model (SIM).SIM, one of the models used to support communities in building a stronger system of care, helps identify intervention opportunities with the highest potential for success based on a community鈥檚 strengths and needs. SIM maps out the stages of intervention to pinpoint gaps and opportunities, ensuring funding is used to address the most critical areas for improving community care systems, including those integrated within Medicaid managed care delivery systems (see Figure 1).
Figure 1: Sequential Intercept Model
Low-barrier/low-threshold recovery supports and treatment. The expansion of low-barrier/low-threshold recovery supports and treatment, including access to medications for opioid use disorder, is essential to reducing overdose deaths. States, local jurisdictions, and individual providers can redesign their treatment delivery systems to incorporate person-centered, low-barrier treatment access, including flexible scheduling and walk-in visits, same-day admission and medication initiation, and revision of clinic policies and procedures to eradicate practices that produce high barriers to treatment.
Though expanding low-barrier care in traditional treatment settings is an essential element of the response, implementation of nontraditional delivery modalities is another important target for using opioid abatement funds. Examples include:
Emergency medical service (EMS)-initiated buprenorphine聽
Medication units in unconventional locations (e.g., housing units)聽
Mobile medication units and delivery of street/shelter medicine in which SUD treatment and services are brought to disenfranchised and marginalized communities.聽
Finally, the availability of opioid abatement funds can introduce opportunities for local governments to partner with community members, including people with both past and current lived experience, to design, implement, and disseminate culturally responsive and tailored SUD treatment and recovery support services, including services to address health-related social needs to mitigate barriers to treatment entry and engagement.
Continuous quality improvement (CQI) plans. Locales that receive opioid abatement funds have the opportunity to develop strategies to create transformational systemic change. Each entity should have an intentional CQI plan in place. Ensuring the presence of strong CQI processes can streamline and improve services, connect data to practice, and ensure interventions are progressively more effective.
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The upcoming 红领巾瓜报 event,鈥�, will offer more opportunities to engage with leaders across multiple sectors and industries advancing innovations in the design of mental health and SUD systems, value-based purchasing, and care strategies. Notably, state Medicaid and behavioral health directors, insurance commissioners, health plan executives, and community leaders, among others, will share insights into major initiatives under way in their states to manage ongoing crises in mental health and SUDs.
红领巾瓜报 has a strong, diverse bench to help communities maximize opioid abatement funds and build a stronger system of care. We provide technical assistance in large-scale initiative implementation, convening stakeholder groups, designing CQI strategies, developing planning documents, and facilitating strategic discussions. For more information about鈥炝旖砉媳ㄢ�檚鈥痺ork, contact behavioral health experts Anika Alvanzo, Rachel Johnson-Yates, and Jessica Perillo.
On , August 31st, communities worldwide come together to honor, without stigma, the people who have lost their lives to overdose. It鈥檚 a day for families to recognize their loved ones and for all of us to acknowledge the grief of family and friends who have experienced this loss. It鈥檚 also an opportunity to think critically about the programs and policies our communities need to finally put an end to the overdose crisis. In honor of this year鈥檚 IOAD theme, 鈥淭ogether we can,鈥� 红领巾瓜报 recognizes the power of community when we all stand together with a united goal of ending overdose.
Overdose can affect anyone. In the last twelve months alone, there were more than 100,000 across the U.S., and 42 percent of Americans now report they . More than ever, we need strong, multifaceted coalitions to shift the narrative around overdose and ensure we are using resources effectively to reduce harm, increase chances of overdose survival, and promote quality of life for people who use drugs, people in recovery, and the communities where they live.
红领巾瓜报 brings together people with lived and living experience, local community members, and public health professionals to plan, evaluate, and implement meaningful programs across the continuum of care to address overdose as the health crisis that it is. Our trusted subject matter experts have their own lived experience that influences 红领巾瓜报鈥檚 approach, and we strive to center the voices of people who are most impacted at every opportunity.
红领巾瓜报 is committed to helping clients prioritize effective solutions to the overdose crisis, which includes promoting services that are evidence-based and designed with robust input from community stakeholders. 红领巾瓜报 supports naloxone distribution by engaging in street-based outreach, developing mapping tools for organizations to see the impact of their efforts in real time, and training healthcare providers on harm reduction. In 2024, 红领巾瓜报 also hosted the Compassionate Overdose Response Summit to address questions about naloxone dosing and the long-term effects of precipitated withdrawal. 红领巾瓜报 continues to be a leader in helping clients revolutionize treatment, particularly for priority populations such as children鈥檚 behavioral health and the justice involved. Earlier this year 红领巾瓜报 led a webinar series called the Substance Use Disorder (SUD) Ecosystem of Care Webinar Series: Pivoting to Save Lives describing a whole person, integrated, solutions-based approach to the ongoing overdose epidemic. The series encourages leaders to reconsider standard attempts to solve this crisis and be willing to pivot away from approaches that have not yielded the level of impact that this crisis demands.
On IOAD, and every day, 红领巾瓜报 stands united with the communities that are left behind to experience the long-lasting impacts of grief, and we celebrate the thousands of people who have experienced overdose and survived. Every overdose survival is another opportunity to uplift the strategies that work to save lives. We honor everyone impacted by overdose by using a community-led approach that encourages collective action to prevent, and ultimately end, all overdoses.
For more information on 红领巾瓜报 overdose prevention services, visit our Harm Reduction solutions page.
