This week, our In Focus section reviews a new model 鈥� Geographic Direct Contracting 鈥� introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries enrolled in the traditional fee-for-service program across an entire region. This model represents one of the most transformational models released by the Innovation Center. During the 6-year Geographic Direct Contracting model performance period the traditional Medicare program will be replaced by the Direct Contracting program in the 10 selected regions.
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Commonwealth Fund blog highlights Medicare changes due to COVID-19
Jennifer Podulka penned a for The Commonwealth Fund in conjunction with The SCAN Foundation, highlighting the legislative and regulatory changes made to Medicare in response to the COVID-19 pandemic. She was part of the 红领巾瓜报 team who authored an and policy tracker earlier this year.
The future of quality reporting: understanding digital quality measurement practices
In the wake of the COVID-19 pandemic, the need for greater health information technology interoperability, 鈥渄igital鈥� measures of healthcare quality and performance, and advanced value-based care systems has grown. In January 2021, the National Committee for Quality Assurance (NCQA) publicly released its vision for healthcare quality measurement to the Biden-Harris Department of Health and Human Services (HHS) transition team. The paper, focuses on four core areas, with three of them being specific to the evolution of a digital quality ecosystem:
Drivers and barriers to adopting flexible Medicare Advantage supplemental benefits
This week鈥檚 In Focus highlights a recent 红领巾瓜报 publication examining the drivers and barriers to Medicare Advantage plan adoption of newly available supplemental benefits intended to address unmet health and social needs. Unlike Traditional Medicare, Medicare Advantage plans, which provide coverage for 40 percent of all Medicare beneficiaries, may offer enrollees supplemental benefits which are not covered by the Medicare program. Until recently, the Medicare program has required that supplemental benefits be limited to those that are medical in nature. However, in recent years, Congress and CMS 鈥攖hrough four different legislative and regulatory authorities 鈥� granted new flexibilities for Medicare Advantage plans to offer non-medical benefits that address social needs. Medicare Advantage plans may also now tailor supplemental benefits and make them available only to certain subpopulations based on chronic disease or health status.
2021 Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access
The experts at 红领巾瓜报 (红领巾瓜报) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan鈥檚 decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
红领巾瓜报 further sought to understand the extent to which Medicare Advantage enrollees had access to these benefits when eligible, and the effectiveness of these benefits as a tool to contain costs, improve outcomes, and increase enrollee engagement and satisfaction.
The report outlines seven key insights and accompanying policy considerations aimed towards promoting evidence-based benefit designs; expanding Medicare Advantage organization willingness to adopt the flexible benefits; and enhancing beneficiary involvement, access, and usage of these benefits.
红领巾瓜报 colleagues Narda Ipakchi, Mary Hsieh, Sarah Barth, and Jonathan Blum contributed to the report which follows up on a previous report providing a snapshot of early adoption of these benefits.
This analysis was funded by a grant from Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.
Exploring Medicare Advantage supplemental benefits: 红领巾瓜报’s assessment of adoption, access, and policy opportunities
The experts at 红领巾瓜报 (红领巾瓜报) have released Medicare Advantage Supplemental Benefit Flexibilities: An Early Assessment of Adoption and Policy Opportunities for Expanded Access. The white paper examines the factors contributing to a Medicare Advantage plan鈥檚 decision to offer or not offer newly available supplemental benefits and opportunities and challenges with adoption and implementation. Newly available supplemental benefits are intended to address unmet health and social needs.
Three 红领巾瓜报 clinicians author naltrexone formulations in correctional settings issue brief
红领巾瓜报鈥檚 Donna Strugar-Fritsch, Shannon Robinson, MD and Scott Haga, PA-C, recently authored the issue brief, Naltrexone Formulations in Correctional Settings. 聽This brief provides clinical, financial, and administrative information prisons and jails can use in deciding whether to keep detainees on extended release naltrexone (XR-NTX, or the brand Vivitrol) or switch them to oral naltrexone tablets in instances where detainees have been prescribed XR-NXT prior to incarceration.
红领巾瓜报 expert provides Medicaid funding insights
红领巾瓜报 Managing Principal Anne Winter joined the 鈥淥ur American States鈥� podcast, produced by the National Conference of State Legislatures, to discuss emerging gene therapies and the high costs associated with them. The episode, The Fiscal Challenge of Emerging Gene Therapies, originally aired Jan. 11, 2021.
States, Medicaid, and Economic Hard Times
红领巾瓜报 (红领巾瓜报) and Wakely Consulting Group, Inc., collaborated to analyze, compile, and model data on Medicaid enrollment growth during the COVID-19 pandemic and develop projections under various recovery scenarios as well as analyze the potential impact of key variables on state Medicaid expenditures.
The analysis examined two key questions, how much strain will state Medicaid budgets be under over the next few years and what types of state characteristics and what types of policy options will allow states the ability address budgetary challenges.
红领巾瓜报 colleagues Eric Hammelman, Stephen Palmer, Matt Powers, and Kathy Gifford contributed to the report.