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10/18/19 – Whistleblower Alleges Fraud at a large Medicare Advantage Plan in Seattle – Kaiser Health News

Group Health Cooperative in Seattle, one of the United States' oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.
 

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10/17/19 – What the Health?: Democrats Do Drugs (Prices) – Kaiser Health News 

Despite the turmoil from the ongoing impeachment inquiry, Democrats in the U.S. House of Representatives are proceeding with work on a major prescription drug price bill crafted by Speaker Nancy Pelosi.
 

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10/17/19 - Senator Collins Calls on Social Security Administration to Strengthen Efforts to Combat Scam

The Senate Aging Committee’s Fraud Hotline has received a significant increase in complaints about Social Security Scam since last year.

U.S. Senator Susan Collins, the Chairman of the Aging Committee, urged the Social Security Administration (SSA) to strengthen its response to the Social Security scam that seeks to rob Americans of their hard-earned savings.  In a letter to SSA Commissioner Andrew Saul, Senator Collins made clear that she expects the agency to take concrete action to protect seniors and requested additional information on the steps SSA has taken thus far.
 

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10/16/19 - Senate Aging Committee Releases Report on Falls Prevention, Holds Hearing on Proven Strategies to Protect Seniors from Injury

The Senate Aging Committee held a hearing titled “Falls Prevention: National, State, and Local Level Solutions to Better Support Seniors,” which focused on the health and economic consequences of falls and explored strategies to prevent and reduce falls-related injuries. 
 “Falls are the leading cause of fatal and non-fatal injuries for older Americans, often leading to a downward spiral with serious consequences. In addition to the physical and emotional trauma of falls, the financial toll is staggering,” said Senator Collins.  “Now is the time, and now is our opportunity, to take action to prevent falls. Our bipartisan report includes key recommendations to take steps to reduce the risk of falls.”
 

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10/15/19 – Dealing with the Challenges of Aging – National Care Planning Council – By: Thomas Day

Every working day at the National Care Planning Council we receive numerous requests from the public for assistance for aging seniors. Most of these requests are submissions of online forms for our members which go directly to their emails. Some of these requests come directly to us. And somewhere between 3 to 10 email or phone requests a day come from individuals seeking where to find information on veterans benefits.
 

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10/14/19 – Medicare Open Enrollment FAQs – Kaiser Family Foundation

This list of Frequently Asked Questions (FAQs) about Medicare Open Enrollment covers a range of topics related to Medicare enrollment, Medicare Advantage, Part D, Medigap, employer/retiree coverage, Medicaid and other low-income assistance, Medicare and the Marketplaces, and more.

Read more.


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10/8/19 - New National Initiative on Advancing Integrated Models for People with Complex Needs Announced

The Center for Health Care Strategies (CHCS) today announces Advancing Integrated Models (AIM), a national, multi-site demonstration promoting innovative, person-centered strategies to improve care for adults and children with complex health and social needs. Made possible with support from the Robert Wood Johnson Foundation and led by CHCS, AIM will assist eight health system and provider organizations in designing and piloting novel approaches to integrate care for people with complex needs with a focus on improving health outcomes and fostering health equity.
 

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10/01/19 – What is the Greatest Risk for Retired Seniors? 

By: Thomas Day

By far, the greatest risk for retired seniors, especially those who are advanced in age, is the need for long-term care services. U.S. Department of Health and Human Services projections estimate that 70 percent of Americans who reach the age of 65 will need some form of long-term care in their lives for an average of 3 years. (See HHS Administration on Aging website) 
 

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09/30/19 Interest In ‘Pathways To Success’ Grows: 2018 ACO Results Show Trends Supporting Program Redesign Continue

By: Seema Verma

With Medicare’s main trust fund projected to run out in just seven years, the Trump Administration is working hard to lower health care costs and increase quality to protect the Medicare program for all Americans who depend on it. The Medicare Shared Savings Program (Shared Savings Program), established by Congress, promotes accountability for a patient population, fosters coordination of care, encourages investment in infrastructure and redesigned care processes for high quality and efficient health care service delivery, and promotes higher value care. The Shared Savings Program is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an Accountable Care Organization (ACO) to lower growth in expenditures and improve quality.
 

 


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9/30/19 – Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

By:Alexandra Kruse, Center for Health Care Strategies

Starting January 1, 2021, under a new rule recently released by the Centers for Medicare & Medicaid Services (CMS), many Dual Eligible Special Needs Plans (D-SNPs) will be required to notify the state Medicaid agencies they contract with (or the state’s designee) when their enrollees are admitted to a hospital or skilled nursing facility (SNF).1,2 This requirement applies to any D-SNP that is not contracted, either directly or through an affiliated Medicaid managed care organization (MCO), to cover either Medicaid behavioral health or long-term care benefits. The goal of the new rule is to ensure timely initiation of Medicaid care management activities around care transitions for at least one group of high-risk beneficiaries. This may, in turn, help lower readmission rates and more effectively support enrollees’ return to the community. The new rule provides states with more opportunities to help ensure that beneficiaries receive care in the right settings at the right time.
 

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9/30/19 – Medicare-Medicaid Plan (MMP) Technical Guide to Eligibility and Enrollment Transaction Processing

By:  Infocrossing

This guide describes the interface that states with Financial Alignment Initiative Demonstrations use to conduct Medicare eligibility verification and MMP enrollment submission to the CMS MARx systems. Version 3.1 of the Guide reflects the addition of historical Medicare beneficiary Part A and Part B entitlement start and end dates on all Medicare Eligibility query mediums produced by Infocrossing. This change is effective October 1, 2019. Version 3.1 of the Guide also introduces Infocrossing’s new RESTful Eligibility Web Service. MMPs and state agencies can now use the RESTful Eligbility web service in conjunction with or as a replacement to the existing web service tool, at their own discretion. The revision history section of the document details these changes.
 

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9/30/19 - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, September 2018 to September 2019

By: Integrated Care Resource Center

This resource reports data on the most recent 12 months of enrollment in capitated model demonstrations under the Financial Alignment Initiative.
 

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9/26/19 - The Delicate Issue Of Taking Away A Senior’s Smartphone

By: Judith Graham

At first, Dr. Robert Zorowitz thought his 83-year-old mother was confused. She couldn’t remember passwords to accounts on her computer. She would call and say programs had stopped working. But over time, Zorowitz realized his mother — a highly intelligent woman who was comfortable with technology ― was showing early signs of dementia.
Increasingly, families will encounter similar concerns as older adults become reliant on computers, cellphones and tablets: With cognitive impairment, these devices become difficult to use and, in some cases, problematic.
 

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9/25/19 – Report: Preparing the Current and Future Health Care Workforce for Interprofessional Practice in Sustainable, Age-Friendly Health Systems

By: Health Resources & Services Administration

More people in the United States are living healthier lives past 65 years of age and continuing to contribute to society in countless ways; yet, the number of health care professionals specializing in their care, while increasing slowly, has not kept pace with the growing demographics of older adults. By 2030, there will be a need for over a million additional health care professionals just to maintain the current provider-to-population ratios. Presently, the U.S. health care system does not effectively meet the complex needs of the aging population, despite multiple initiatives to create programs and services to provide safe and highly effective care of older adults. Major health care systems are currently participating in a national initiative aimed at transforming 20% of U.S. hospitals and primary care practices to Age-Friendly Health Systems by 2020.
 

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9/17/19 - New ICRC Resource | Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation 

Starting in 2021, Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) not providing coverage of Medicaid long-term services and supports or behavioral health benefits will be required to notify the state or the state’s designee when their enrollees are admitted to a hospital or skilled nursing facility. The goal of these admission notifications is to ensure timely initiation of care management activities around transitions of care, and, in turn, help lower readmission rates and more effectively support D-SNP enrollees to return to community based settings.
 

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9/13/19 - Congressional Briefing: What’s Next on Social Determinants of Health? Public Briefing

It has become increasingly clear that efforts to improve quality, lower costs, and enhance patient satisfaction cannot succeed without addressing socioeconomic status and nonmedical drivers of health—often called “social determinants of health”. However, the financing and oversight of holistic community initiatives is complicated, as they often involve a spectrum of municipal services, private entities, and all levels of government. This briefing will explore the economic, budgetary, and infrastructure issues that arise when creating outcome-oriented investments for social determinants of health.
 

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9/13/19 – MedPAC comment on CMS’s proposed rule on CY 2020 revisions to payment policies under the physician fee schedule and other changes to Part B payment policies.

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services (CMS) proposed rule entitled: “Medicare Program; CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Establishment of an Ambulance Data Collection System; Updates to the Quality Payment Program; Medicare Enrollment of Opioid Treatment Programs and Enhancements to Provider Enrollment Regulations Concerning Improper Prescribing and Patient Harm; and Amendments to Physician Self-Referral Law Advisory Opinion Regulations,” published in the Federal Register, vol. 84, no. 157, pages 40482 to 41289. We appreciate your staff’s ongoing efforts to administer and improve payment systems for physician and other health professional services (including implementing the Quality Payment Program and Medicare Shared Savings Program), particularly considering the competing demands on the agency.
 

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9/12/19 - Poll: Most Democrats Prefer a Presidential Candidate Who Wants to Build on the Affordable Care Act

The latest KFF Health Tracking Poll probes Democrats’ views about the general approaches to expanding health coverage and lowering costs put forward by the candidates.
Most Democrats and Democratic-leaning independents (55%) say they prefer a candidate who would build on the Affordable Care Act to achieve those goals. Fewer (40%) prefer a candidate who would replace the ACA with a Medicare-for-all plan.
 

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9/9/19 – Kaiser Health News - Millions Of Diabetes Patients Are Missing Out On Medicare’s Nutrition Help

The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million enrollees in private Medicare Advantage plans.
 

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8/28/19 - ABC News - Doctors don't always know what patients will owe for meds

While the price of almost any good or service can be found online, most Americans don't know what they'll owe for a prescription medication until they get it. Unexpected costs contribute to the estimated 20 to 30 percent of prescriptions that are never filled, which can lead to health problems from untreated medical conditions.
 

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8/28/19 –Poll:  Support rises for 2020 Democrats favoring “Medicare for All”

By: Tal Axelrod – The Hill

 

 

 


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08/2019 – Promoting Information Sharing by Dual Eligible Special Needs Plans to Improve Care Transitions: State Options and Considerations

By: Alexandra Kruse and Nancy Archibald, Center for Health Care Strategies, and Rebecca Lester, Mathematica

 
Many states contract with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) to provide Medicare services to individuals dually eligible for Medicare and Medicaid, but they do not require these D-SNPs to provide coverage of Medicaid long-term services and supports or behavioral health benefits. Starting in 2021, under a recently released rule from the Centers for Medicare & Medicaid Services, these D-SNPs will now be required to notify the state or state’s designee when enrollees experience Medicare-covered hospital or skilled nursing facility admissions.
 
This brief examines approaches used by three states — Oregon, Pennsylvania, and Tennessee — to develop and implement information-sharing processes for their D-SNPs that support care transitions. It also includes examples of contract language and strategies to encourage plan collaboration around information sharing. It can help states, D-SNPs, and other stakeholders assess how to meet the new D-SNP contracting requirements and improve care for dually eligible individuals.
 

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08/06/2019 – What is the Difference between Conservatorship and Guardianship?

National Care Planning Council – By: Thomas Day

Sometimes it may be necessary to pursue a conservatorship or guardianship for a person who is not able to make or communicate decisions. Unlike a power of attorney, an individual appointed as a conservator or guardian can make decisions on behalf of the person being protected and those decisions cannot be overridden by the protected person. In a sense, in order to shield the protected person or the community from harm, the protected person's freedom regarding the specific decisions being overseen by the court or legal document has been taken away.
 
 

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08/05/2019 - As Policymakers Debate Medicare-for-All, Analysis Finds the Medicare Advantage, Individual and Group Health Insurance Markets Appear to Be Profitable, Especially Medicare Advantage

By:  Chris Lee, Henry J Kaiser Family Foundation

Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers, according to a new KFF analysis.
 
 

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08/01/2019 – What Steps are Washington Policymakers Pursuing to Control Medicare Prescription Drug Spending? 

By:  Chris Lee, Henry J. Kaiser Family Foundatoin

The affordability of prescription drugs is a pressing concern for many Americans, with broad agreement across the political spectrum that lowering prescription drug costs should be a top priority for Congress. The Trump Administration, members of Congress, and several 2020 presidential candidates have offered proposals to lower drug prices. Many of these proposals would affect prescription drug spending under Medicare, which accounts for 30 percent of national retail spending on drugs and nearly $1 out of every $5 in total Medicare spending.
 
 

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7/24/19 - Kaiser Health News - Summer Setbacks: The Long Road To Lower Drug Prices Hits Some Potholes

By Emmarie Huetteman

When Washington returned from its winter holiday break in January, it seemed everyone was talking about lowering drug prices.

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07/09/2019 - ACL - HUD Announces $150 Million in Mainstream Housing Voucher Funding

The U.S. Department of Housing and Urban Development (HUD) has announced a notice of funding availability for Mainstream (Section 811) Vouchers. The funding will be awarded to public housing agencies (PHAs) to support vouchers that provide sustained community-based integrated housing opportunities to non-elderly people with disabilities. HUD expects to award $150 million to house approximately 18,000 families.

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7/3/19 – ICRC – Program of All Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization

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6/25/2019 – CHCS – Understanding the Roles of Medicaid and Public Health in CDC’s 6/18 Initiative: Primers and FAQs

Across the country, health care stakeholders — including Medicaid and public health representatives — are seeking to change how they work by forging new partnerships and breaking down silos to enhance care, improve health outcomes, and control health care costs.

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6/25/2019 – MedPAC – Medicare Payment Advisory Commission Releases Report on Medicare and the Health Care Delivery System

Today the Medicare Payment Advisory Commission (MedPAC) releases its June 2019 Report to the Congress: Medicare and the Health Care Delivery System. Each June, as part of its mandate from the Congress, MedPAC reports on issues affecting the Medicare program as well as broader changes in health care delivery and the market for health care services.

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Click here to view fact sheet

Click here to view full report


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6/11/2019 – Kaiser Family Foundation – Data Note:  Americans’ Challenges with Health Care Costs

By Ashley Kirzinger, Cailey Munana, Bryan Wu, and Mollyann Brodie

The cost of health care affects every aspect of the U.S. health care system. It dominates political discussions on health care, impacts decisions about insurance coverage, and ranks at the top of things Americans worry about. It also plays a significant role in the patient experience from decisions on whether or not to get care to the impact of medical bills after receiving care. This data note summarizes the most recent Kaiser Family Foundation polling on the public’s experiences with and worries about health care costs.

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5/24/19 – Kaiser Health News – Analysis: A Healthcare Overhaul Could Kill 2 Million Jobs , And That’s OK

As calls for radical health reform grow louder, many on the right, in the center and in the health care industry are arguing that proposals like “Medicare for All” would cause economic ruin, decimating a sector that represents nearly 20% of our economy.

Read More

 

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5/23/19 – The Commonwealth Fund – How Much U.S. Households with Employer Insurance Spend on Premiums and Out-of-Pocket Costs: A State by State Look

By Susan L. Hayes, Sara R. Collins and David C. Radley

In the years since the Affordable Care Act (ACA) took effect, public debate over the cost and quality of insurance has focused primarily on health plans sold through the marketplaces established by the law. There has been less attention on the 158 million Americans who have employer-based coverage.

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5/21/19 – The Office of the National Coordinator for Health Information Technology - Trends in Individuals’ Access, Viewing and Use of Online Medical Records and Other Technology for Health Needs: 2017 - 2018

By Vaishali Patel and Christian Johnson

The access, exchange, and use of electronic health information is essential for individuals to better manage their health care needs and share information with their providers and caregivers. Many hospitals and physicians possess capabilities that enable patients to view and download their health information. However, additional steps are needed to make health information more accessible and useful to individuals (1, 2). A majority of individuals have smartphones and use applications (apps) to help them manage various tasks. The 21st Century Cures Act emphasizes the importance of making patient health information more easily accessible and the need for greater education regarding patients’ rights to access their health information (3). This data brief uses the Health Information Trends Survey (HINTS), a nationally representative survey, to assess individuals’ access, viewing and use of their online medical records, and the use of smartphone health apps and other electronic devices in 2017 and 2018.

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5/14/19 – CHCS – Opportunities to Advance Complex Care in Rural and Frontier Areas

By Jim Lloyd

People with complex care needs who live in rural communities face many of the same challenges experienced by individuals in urban areas, such as lack of transportation and food insecurity. However, rural communities are not just scaled-down cities. Despite facing similar challenges to patients living in urban areas, individuals with complex needs in rural areas often face additional hurdles caused by lack of infrastructure and geographic distances, making many high-touch complex care interventions difficult — if not impossible — to implement.

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5/10/19 – ASPE – Assessing the Costs and Benefits of Extending Coverage of Immunosuppressive Drugs under Medicare

By statute, the majority of patients with end-stage renal disease (ESRD) are eligible for Medicare, regardless of age. Kidney transplantation is ultimately considered the best treatment for ESRD, but ESRD-related eligibility for Medicare coverage extends for only 36 months post-transplant. Given the costs to Medicare associated with patients who stop taking immunosuppressive drugs due to cost and revert to developing ESRD, requiring subsequent dialysis and/or kidney transplantation, ASPE analyzed the financial implications of extending Medicare coverage of only immunosuppressive drugs for the lifetime of the patient. We estimate that extending Medicare coverage of immunosuppressive drugs beyond three years post-transplant would result in ten-year accumulated savings of approximately $73 million.

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5/10/19 – ASPE – The Special Diabetes Program for Indians: Estimates of Medicare Savings

Between 1996 and 2013, there was a 54% decrease in the incidence of diabetes-related end-stage renal disease (ESRD-DM) in American Indian and Alaska Native (AI/ AN) populations. This decline has occurred since the Special Diabetes Program for Indians (SDPI) was established in 1997. We estimate that the decrease in ESRD-DM incidence resulted in 2,200 to 2,600 fewer cases and $436 to $520 million of savings to Medicare over a ten-year period, depending on assumptions of what the incidence rate would have been in the absence of diabetic care improvements. Additional savings from the program may accrue to the Indian Health Service and other payers by preventing diabetes and other complications of diabetes such as retinopathy or hospitalizations. Although it is not possible to determine with certainty how much of the decline in ESRD-DM is attributable to SDPI, nothing else has impacted diabetes resources across Indian health care systems as much as SDPI over the past 20 years and improvements in related outcomes in the Al/AN population far surpass those observed in other races.

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5/08/19 – MedPAC – Medicare Physician Payment Reform after Two Years: Examining MACRA Implementation and the Road Ahead

The Medicare Payment Advisory Commission (MedPAC) is a small congressional support agency established by the Balanced Budget Act of 1997 (P.L. 105–33) to provide independent, nonpartisan policy and technical advice to the Congress on issues affecting the Medicare program. The Commission’s goal is a Medicare program that ensures beneficiary access to highquality, well-coordinated care; pays health care providers and health plans fairly, rewarding efficiency and quality; and spends taxpayer and beneficiary dollars responsibly. The Commission thanks Chairman Grassley and Ranking Member Wyden for the opportunity to submit a statement for the record today.

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5/01/19 – ASPE – 2018 HHS Data Strategy: Enhancing the HHS Evidence-Based Portfolio

The 2018 HHS Data Strategy focuses on improving the Department’s capacity to develop statistical evidence to support policymaking and program evaluation over the next six to eight years. As the principal internal advisory body to the Secretary of Health and Human Services on the Department’s data and statistical policy, the HHS Data Council develops, implements, and updates the Department’s data strategy. Various efforts in HHS and throughout the federal government, including the President’s Management Agenda, Reimagine HHS, and the Report of the Commission on Evidenced-Based Policymaking (CEP) have called for leveraging data to provide insight into the effectiveness of programs and to inform decision making. The newly enacted law, “The Foundations for Evidence Based Policymaking Act of 2018,” which the President signed into law on January 14, 2019, puts a further mandate on HHS to improve its capacity for using data for evidence building purposes. There are six priorities outlined in the strategy: 1) improving access to HHS data, 2) enhancing administrative data for research, 3) increasing data linkages across diverse data assets, 4) modernizing privacy protections, 5) increasing data policy coordination and information sharing across the department, and 6) building a 21st Century data-oriented workforce.

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4/15/19 – Kaiser Family Foundation – How Affordability of Health Care Varies by Income among People with Employer Coverage

The affordability of health insurance and health care continue to be key public concerns.  While recent policy discussions have largely focused on the adequacy of financial assistance for those covered in the Affordable Care Act marketplaces and the nongroup market, millions of people with low incomes get their coverage through a workplace, where there are fewer protections from high costs.

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4/08/19 – CHCS – Center for Health Care Strategies Board of Trustees Names New President and Chief Executive Officer

Today, the Center for Health Care Strategies (CHCS) Board of Trustees announced the selection of Allison Hamblin, MSPH, as the next president and chief executive officer (CEO) for the organization, effective July 1, 2019. Ms. Hamblin will replace Stephen A. Somers, PhD, CHCS’ current president, CEO, and founder, who will be stepping down after 24 years.

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4/05/19 – MedPAC – MedPAC Comment on OIG’s Proposed Rule on Safe Harbor Regulation of Prescription Drug Rebates

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Office of Inspector General (OIG) proposed rule entitled “Removal of safe harbor protection for rebates involving prescription pharmaceuticals and creation of new safe harbor protection for certain point-of-sale reductions in price on prescription pharmaceuticals and certain pharmacy benefit manager service fees,” published in the Federal Register, vol. 84, no. 25, pages 2340 to 2363. We appreciate your staff’s work on the proposed rule, particularly considering the competing demands on the office.

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4/03/19 – CHCS – Strengthening Medicaid Long-Term Services and Supports in an Evolving Policy Environment: A Toolkit for States

By Stephanie Anthony, Arielle Traub, Sarah Lewis, Cindy Mann, Alexandra Kruse, Michelle Herman Soper, and Stephen A. Somers

Long-term services and supports (LTSS) enable more than 12 million people to meet their personal care needs and live with dignity and independence in a variety of community and institutional settings. With Medicaid LTSS expenditures of more than $154 billion annually and the aging population projected to grow 18 percent by 2020, the increasing demand for LTSS is putting more pressure on Medicaid at both the federal and state levels.

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Click here to view full tool kit

Click here to view summary of reforms

Click here to view brief for legislators


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4/03/19 – CHCS – Alternative Staffing Models to Improve Care for Complex Patients in their Homes and Other Settings: Early Findings from the Transforming Complex Care Initiative

By Derek DeLia and Jolene Chou

Through the Transforming Complex Care initiative, a national initiative led by the Center for Health Care Strategies with support from the Robert Wood Johnson Foundation, six complex care programs were tasked with refining and spreading effective care models that addressed the complex medical and social needs of high-need, high-cost patients.

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4/01/19 – Kaiser Family Foundation – Suicide Risk Grew After Missouri Medicaid Kids Shifted to Managed Care, Hospitals Say

By Phil Galewitz

After more than 2,000 Missouri children diagnosed with mental illness were shifted from traditional Medicaid into three for-profit managed-care companies, the state’s hospitals noticed an alarming trend: a doubling in the percentage who had thoughts of suicide or attempted suicide.

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3/29/19 – The Commonwealth Fund – Choosing Wisely: An International Movement Toward Appropriate Medical Care

By Shanoor Seervai

A hot dog with too much mustard on it. A washing machine overflowing with soap suds. A suitcase with clothes spilling out of it. These images aren’t what you expect to see when you go to your doctor — but in primary care waiting rooms across Canada, posters with these images hang on the walls.

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3/29/19 – Kaiser Family Foundation – CMS Ignores Federal Judge Ruling to Approve Medicaid Work Rules in Utah

By Phil Galewitz

Less than 48 hours after a federal judge struck down Medicaid work requirements, the Centers for Medicare & Medicaid Services on Friday gave Utah permission to use those mandates.

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3/26/19 – The Commonwealth Fund – Pharmacy Benefit Managers: Practices, Controversies, and What Lies Ahead

By Elizabeth Seeley and Aaron S. Kesselheim

Pharmacy benefit managers (PBMs) are responsible for negotiating payment rates for a large share of prescription drugs distributed in the U.S. Recently, policymakers have expressed concern that certain PBMs’ business practices may not be consistent with public policy goals to improve the value of pharmaceutical spending.

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3/18/19 – Kaiser Family Foundation – Death by 1,000 Clicks: Where Electronic Health Records Went Wrong

By Fred Schulte and Erika Fry

The pain radiated from the top of Annette Monachelli’s head, and it got worse when she changed positions. It didn’t feel like her usual migraine. The 47-year-old Vermont attorney turned innkeeper visited her local doctor at the Stowe Family Practice twice about the problem in late November 2012, but got little relief.

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3/18/19 – MedPAC – Medicare Payment Advisory Commission Releases Report to Congress on Medicare Payment Policy

Today, the Medicare Payment Advisory Commission (MedPAC) releases its March 2019 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in fee-for-service (FFS) Medicare and reviews the status of Medicare Advantage (MA) and the prescription drug benefit, Part D. Also, MedPAC recommends that the Congress replace the four current hospital quality payment programs with a single streamlined program—the hospital value incentive program (HVIP). Lastly, as mandated by the Congress, we report on incentives for prescribing opioid and non-opioid pain treatment under Medicare’s hospital inpatient and outpatient payment systems.

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Click here to view fact sheet


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3/14/19 – The Commonwealth Fund – How Will Medicaid Work Requirements Affect Hospitals’ Finances?

By Randy Haught, Allen Dobson and Phap-Hoa Luu

The recent debate regarding Section 1115 demonstration waivers that include work requirements has focused on potential loss of coverage for Medicaid beneficiaries, but little has been discussed about the potential impact on providers that serve Medicaid patients.

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3/05/19 – CHCS – Opportunities for Complex Care Programs to Address the Social Determinants of Health

By Meryl Schulman and Caitlin Thomas-Henkel

In recognition of the underlying social, economic, and environmental factors that contribute to poor health outcomes, many complex care programs are incorporating strategies to address the social determinants of health (SDOH). This brief explores opportunities to better meet patients’ social needs, including: (1) identifying patients’ non-medical needs; (2) employing non-traditional workers; (3) partnering with community-based organizations and social service agencies; (4) testing new uses for technology to help address social needs; and (5) identifying sustainable funding to support non-medical services. It features organizations that participated in Transforming Complex Care, a national initiative aimed at advancing innovations in complex care led by the Center for Health Care Strategies and supported by the Robert Wood Johnson Foundation.

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3/01/19 – MedPAC – MedPAC Comment on CMS’s Advance Notice of Methodological Changes for CY 2020 for Medicare Advantage (Parts 1 and 2)

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS’s) December 20, 2018 “Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for the Medicare Advantage (MA) CMS–HCC Risk Adjustment Model” and the January 30, 2019 “Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2020 Draft Call Letter.” We appreciate your staff’s work on the notice, particularly considering the statutory requirements for extensive changes to the risk adjustment model.

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3/01/19 – Kaiser Family Foundation – Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State

This page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. Scroll down or click on the links below to jump to resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.

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3/01/19 – Kaiser Health News – Medicare Trims Payments to 800 Hospitals, Citing Patient Safety Incidents

By Jordan Ray

Eight hundred hospitals will be paid less by Medicare this year because of high rates of infections and patient injuries, federal records show.

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2/27/19 – CHCS – Aligning Early Childhood and Medicaid

The health care system is often the first social sector to connect with the at-risk population of infants in low-income families. With Medicaid covering more than half of all births in many states, and 40 percent of children nationwide, state Medicaid leadership is particularly well-positioned to spur innovations that can improve outcomes for young children and their parents. However, in most states the connection between the health care and early childhood sectors is, at best, tenuous, and Medicaid’s potential to support early childhood and family services is largely untapped. Advancing greater alignment between Medicaid and early childhood-serving agencies is critical to identifying upstream opportunities that reduce adverse childhood experiences. Intervening during the first 1,000 days of life can potentially generate long-term payoffs for young children, as well as the social systems that will serve them into adolescence and adulthood.

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Click here to view press release


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2/22/19 – ASPE – Expanding Access to Family-Centered Medication

Assisted Treatment Issue Brief

This Issue Brief represents the finding of a white paper prepared by RTI under funding from ASPE. The analysis included a programs scan of policy initiatives in 21 states and individual interviews with academics, federal experts, state officials and individual providers.

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2/21/19 – The Commonwealth Fund – Coping with Serious Illness in America: Relying on Family and Friends

By Corinne Lewis, Melinda K. Abrams, Eric C. Schneider, and Tanya Shah

The luckiest among us have family and friends to lean on when times get tough. For those who develop a serious illness — an often painful and tumultuous experience — family and friends offer crucial emotional support and help with day-to-day activities. A recent survey of the sickest adults in America, conducted by the Harvard T. H. Chan School of Public Health, the New York Times, and the Commonwealth Fund, found that seriously ill adults also rely on their family and friends to organize their health care, helping them navigate an often complex, confusing, and inefficient system.

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2/15/19 – Kaiser Family Fund – Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs

By Katherine Young

This analysis examines Medicaid outpatient prescription drug utilization in terms of prescriptions and spending before rebates over the 2014 to 2017 period. 

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2/14/19 – The Commonwealth Fund – Market Concentration and Potential Competition in Medicare Advantage

By Richard G. Frank and Thomas G. McGuire

Medicare Advantage (MA), the private option to traditional Medicare, now serves roughly 37 percent of beneficiaries. Congress intended MA plans to achieve efficiencies in the provision of health care that lead to savings for Medicare through managed competition among private health plans.

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2/8/19 – ASPE – Perspectives of Physicians in Small Rural Practices on the Medicare Quality Payment Program

By Peter Mendel, Christine Butteroff, Peggy G. Chen, Katherine Sieck, Patrick Orr, Nabeel Sharick Qureshi, and Peter S. Hussey

The Centers for Medicare & Medicaid Services recently launched its Quality Payment Program (QPP), which considerably changes the way physicians are paid under Medicare. There has been significant concern about the ability of small and rural medical practices to successfully participate in the program. The objectives of this research effort were to collect feedback through interviews with physicians in small rural practices on the initial implementation of the QPP to understand the program’s initial rollout and flexibility provisions for small and rural practices and to inform future federal rulemaking for the QPP.

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2/06/19 – ICRC – Program of All Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization

This table provides information on total enrollment in PACE organizations.

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2/05/19 – Kaiser Health News – The U.S. Government Engagement in Global Health: A Primer

Attention to global health by governments, policymakers, media, business leaders, and other institutions has increased markedly in recent decades, with a particular focus on health challenges facing low- and middle-income countries. This has led to growing funding, the establishment of new institutions and global goals, and a burgeoning community of stakeholders.

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2/05/19 – Kaiser Health News – Utah and Idaho Lawmakers Seek to Scale Back Voter-Approved Medicaid Expansions

By Phil Galewitz

Three months after voters in Utah and Idaho defied their recalcitrant state legislatures to expand Medicaid through ballot initiatives, Republican lawmakers in those states are hitting back.

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2/04/19 – The Commonwealth Fund – Reference Pricing in Germany: Implications for U.S. Pharmaceutical Purchasing

By James C. Robinson, Dimitra Panteli and Patricia Ex

The German health care system resembles that of the United States in important ways — it is financed by multiple private payers and relies principally on negotiation rather than regulation to establish prices. New drugs that offer minimal benefits compared with existing alternatives within a therapeutic class are subject to reference pricing; those with incremental benefits are subject to price negotiations. Together, the reference and negotiated pricing systems have held German prices substantially below U.S. equivalents.

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1/31/19 – CHCS – What Makes an Early Childhood Medicaid Partnership Work? Insights from Three Cross-Sector Collaborations

By Daniela Lewey and Amelia Vaughn

Early childhood development has a dramatic effect on future adult populations, as the brain experiences its most rapid growth from ages 0-3. Medicaid covers nearly half of all children ages 0-5, putting it in a unique position to improve future population health by supporting early childhood interventions. Such interventions should address physical health and mental health as well as the social determinants of health affecting the family unit — all of which may be accomplished by breaking down silos across sectors to work together.

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1/21/19 – CHCS – Addressing Medication Complexity Through Community-Based Strategies

With 29 percent of Americans taking five or more medications daily, and 119,000 deaths annually occurring from prescription medication-related issues, it is important to look at medication complexity — a little discussed topic. This infographic illustrates the issue and outlines community-based approaches to address it, such as developing risk algorithms to identify at-risk patients and simplifying medication use through comprehensive medication management. The infographic was produced through the Community Management of Medication Complexity Innovation Lab, an initiative led by the Center for Health Care Strategies with support from the Gordon and Betty Moore Foundation. See also the companion fact sheet, Understanding and Addressing Medication Complexity, and report, Opportunities to Enhance Community-Based Medication Management Strategies for People with Complex Health and Social Needs.

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Click here to view fact sheet


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1/21/19 – CHCS – Project ECHO: Policy Pathways for Sustainability

By Greg Howe and Allison Hamblin

Project ECHO is a telehealth mentoring program that enhances workforce capacity in underserved areas by providing community-based primary care providers with the knowledge to manage patients with complex conditions. As of January 2019, it is operating from more than 150 hubs in 45 states and addressing 100 complex conditions — in addition to an increasing global footprint.

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1/21/19 – CHCS – Blueprint for Complex Care: 11 Opportunities to Strengthen the Field

The United States spends more on health care than any other industrialized nation, and much of that spending is concentrated on a small percentage of individuals with complex health and social needs. The Blueprint for Complex Care aims to drive a collective strategy for advancing the field of care that serves this population. This infographic highlights recommendations for advancing the field, based on input from stakeholders across the country.

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1/16/19 – MedPAC – MedPAC Comment on CMS’s Proposed Rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce OOP Expenses

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services (CMS) proposed rule entitled “Modernizing Part D and Medicare Advantage to lower drug prices and reduce out-of-pocket expenses,” published in the Federal Register, vol. 83, no. 231, pages 62152 to 62201. We appreciate your staff’s work on the notice, particularly considering the competing demands on the agency.

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1/11/19 – The Commonwealth Fund – State Strategies for Establishing Connections to Health Care for Justice-Involved Populations: The Central Role of Medicaid

By Jocelyn Guyer, Kinda Serafi, Deborah Bachrach, and Alixandra Gould

With many states expanding Medicaid eligibility, individuals leaving jail or prison are now often able to enroll in health coverage upon release. It is increasingly clear, however, that coverage alone is insufficient to address the often complex health and social needs of people who cycle between costly hospital and jail stays.

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1/09/19 – Kaiser Family Foundation – CMS’s 2018 Proposed Medicaid Managed Care Rule: A Summary of Major Provisions

By Elizabeth Hinton and MaryBeth Musumeci

Managed care is the predominant Medicaid delivery system in most states, with over two-thirds of beneficiaries enrolled in comprehensive risk-based managed care organizations as of July 2016, and millions of others covered by limited-benefit risk-based plans or primary care case management programs. On November 14, 2018, the Centers for Medicare and Medicaid Services (CMS) proposed revisions to the Medicaid managed care regulations with public comments due by January 14, 2019. CMS previously finalized a major revision to these regulations in 2016. The November 2018 proposed rule is not a wholesale revision of the 2016 final rule but proposes changes in the following key areas.

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1/07/19 – CHCS – Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations

By Diana Crumley, Jim Lloyd, Madeline Pucciarello, and Brittany Stapelfeld

The conditions in which people live, learn, work, and play affect health in myriad ways. State Medicaid agencies are increasingly exploring opportunities to address these social determinants of health (SDOH) in an effort to provide more efficient care and improve health outcomes. As states begin to support these efforts, they are thinking strategically about how best to align SDOH-related activities with other reforms — such as value-based purchasing, care transformation, and the development of cross-sector partnerships.

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Click here to view executive summary

Click here to view full report


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12/11/18 – CHCS – Value-Based Payment in Medicaid Managed Long-Term Services and Supports: A Checklist for States

By Michelle Herman Soper, Debra Lipson and Maria Dominiak

State Medicaid agencies, and their contracted managed care plans, are shifting away from fee-for-service systems to value-based payment (VBP) models that tie provider payment to better outcomes. Although most Medicaid VBP models target medical care, states are beginning to explore payment reforms that encourage quality and outcomes for long-term services and supports.

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Click here to see tool


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12/11/18 – CHCS - Blueprint for Complex Care: A Strategic Plan for Advancing the Field

By Mark Humowiecki, Teagan Kuruna, Rebecca Sax, Margaret Hawthorne, Allison Hamblin, Stefanie Turner, Kedar Mate, Cory Sevin, and Kerri Cullen

The US spends more on healthcare than any other industrialized nation, and much of that spending is concentrated on a small percentage of the population for whom behavioral health and social needs are major contributors to poor health outcomes.

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Click here to view summary


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12/11/18 – CHCS – Driving a Cross-Agency Focus on Equity and Access: Indiana’s Office of Healthy Opportunities

In early 2018, Indiana’s Family and Social Services Administration (FSSA) created the Office of Healthy Opportunities. Dedicated to ensuring that “all Hoosiers have equitable access to the social and physical supports needed to promote health from birth through end-of-life,” the office has three goals: (1) Identify the specific health care related social needs of Hoosiers across the states; (2) connect those in need with existing state and community organizations; and (3) create new policies and programs to provide services where they do not currently exist. To meet these broad goals, FSSA is collaborating with multiple peer agencies, including public and private stakeholders across the state, in rethinking how to optimize, for consumers, the integration and delivery of health and social services.

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11/30/18 – MedPAC – MedPAC Comment on CMS’s Plan to Add Product Categories to the DMEPOS Competitive Bidding Program

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services (CMS) notice of proposed rulemaking entitled “Medicare and Medicaid programs: Regulation to require drug pricing transparency,” published in the Federal Register, vol. 83, no. 202, pages 52789 to 52799. We appreciate your staff’s work on the notice, particularly considering the competing demands on the agency.

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11/30/18 – MedPAC – MedPAC Comment on CMS’s Proposed Rule on Requiring Drug Pricing Transparency

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services (CMS) notice of proposed rulemaking entitled “Medicare and Medicaid programs: Regulation to require drug pricing transparency,” published in the Federal Register, vol. 83, no. 202, pages 52789 to 52799. We appreciate your staff’s work on the notice, particularly considering the competing demands on the agency.

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11/27/18 –  Kaiser Family Foundation  - Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State

This page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. Scroll down or click on the links below to jump to resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.

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11/20/18 –  The Commonwealth Fund - Immigrant Women’s Access to Sexual and Reproductive Health Coverage and Care in the United States

By Kinsey Hasstedt, Sheila Desai and Zohra Ansari-Thomasoday

Immigrant women of reproductive age in the U.S. face significant challenges obtaining comprehensive and affordable health insurance coverage and care — including sexual and reproductive health services — compared with U.S.-born women, because of myriad policy and systemic factors.
 

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11/13/18 –  Kaiser Health News – With Hospitalization Losing Favor, Judges Order Outpatient Mental Health Treatment

By Carmen Heredia Rodriguez

When mental illness hijacks Margaret Rodgers’ mind, she acts out.

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11/13/18 –  CHCS - Helping States Support Families Caring for an Aging America

More than 17 million individuals in the United States provide care and support to an older parent, spouse, friend, or neighbor. While states are the primary payers for long-term services and supports (LTSS), in many cases their health care and social service systems are not prepared to meet the needs of an aging population or their caregivers.

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Click here to view press release


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10/30/18 – CHCS– Inclusion and Exclusion Criteria for Complex Care Programs: Survey of Approaches

Around the country, innovative health care organizations are developing programs to better coordinate care for people with complex medical, behavioral health, and social needs. As a first step, organizations need to consistently and efficiently identify individuals in their patient population who can benefit from enhanced care coordination and also determine when to “graduate” patients out of their programs. The Center for Health Care Strategies surveyed organizations involved in its Transforming Complex Care and Complex Care Innovation Lab initiatives to find out how they are identifying individuals for their respective complex care programs. Although this field is still emerging, the criteria used by these innovators can help inform other programs seeking to develop or refine eligibility criteria for complex care management programs.
 

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10/30/18 - ACL - Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Health Care Utilization

By James Mabli, Arkadipta Ghosh, Bob Schmitz, Marisa Shenk, Erin Panzarella, Barbara Carlson, and Mark Flick

The 2018 evaluation of the Older Americans Act (OAA) Nutrition Services Program (NSP) Outcomes Report Part II describes the effect of the OAA Title III-C NSP on participants’ Medicare-funded health care utilization. Part I of this report, available on the ACL website, provided statistical evidence that the OAA Title III-C nutrition programs are fulfilling the statutory purpose: reducing hunger and food insecurity, promoting socialization and promoting health and well-being through providing a nutritious meal. 
 

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10/26/18 – ASPE – 2019 Health Plan Choice and Premiums in Healthcare.gov States

This brief presents information on qualified health plans (QHPs) available in states that rely on the HealthCare.gov eligibility and enrollment platform (HealthCare.gov states), including estimates for issuer participation, consumer options, average premiums, and subsidies in the upcoming open enrollment period (OEP), and trends since the first OEP. National estimates and summary tables are presented in each section of the text. State-specific estimates are in the Appendix. Unless otherwise specified, all estimates reflect all states using the HealthCare.gov platform for each given year.

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10/25/18 – ASPE – Comparison of U.S. and International Prices for Top Medicare Part B Drugs by Total Expenditures

The prices charged by drug manufacturers to wholesalers and distributors (commonly referred to as ex-manufacturers prices) in the United States are 1.8 times higher than in other countries for the top drugs by total expenditures separately paid under Medicare Part B. U.S. prices were higher for most of the drugs included in the analysis, and U.S. prices were more likely to be the highest prices paid among the countries in our study.

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10/22/18 – The Commonwealth Fund - The Potential Implications of Work Requirements for the Insurance Coverage of Medicaid Beneficiaries: The Case of Kentucky

By Sara R. Collins, Sherry A. Glied and Adlan Jackson

With encouragement from the Trump administration, 14 states have received approval for or are pursuing work requirements for nondisabled Medicaid beneficiaries. The requirements have sparked controversy, including two legal challenges.

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10/17/18 – The Commonwealth Fund – Health Care in America

The Experience of People with Serious Illness

By Eric C. Schneider, Melinda Abrams, Arnav Shah, Corrine Lewis, and Tanya Shah

Most Americans expect the health care system will deliver effective treatment and support them through trying times when they get sick. But in reality, health care in America sometimes hurts even as it helps. Appointments can be difficult to get. Clinics and emergency rooms are often overcrowded. Doctors’ recommendations can be confusing and difficult to follow. And when the bills arrive, the costs can be unexpected and devastating. More than 40 million adults in the United States experienced serious illness in the past three years. More than 41 million provided unpaid care to elderly adults during the past year.

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10/16/18 – Kaiser Family Foundation - What Are the Latest Trends in Medicaid?

Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019 at a Forum with the National Association of Medicaid Director

At 9:30 a.m. ET on Thursday, Oct. 25, KFF (the Kaiser Family Foundation) will release its 18th annual 50-state Medicaid budget survey for state fiscal years 2018 and 2019. KFF and the National Association of Medicaid Directors (NAMD) will hold a joint briefing to discuss trends in enrollment and spending and highlight key policy developments at a time when the majority of states are focused on quality and outcomes while some are pursing policies that could restrict Medicaid coverage.
 

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10/16/18 – Kaiser Family Foundation - People on Medicare Will Be Able to Choose Among 24 Medicare Advantage Plans and 27 Medicare Part D Drug Plans, on Average, During the Open Enrollment Period for 2019, New Analyses Find

With Medicare Advantage playing an increasingly larger role in Medicare, the average person on Medicare will be able to choose among 24 plans during the annual Medicare open enrollment period that began Oct. 15, finds a new analysis from KFF (the Kaiser Family Foundation).

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10/15/18 – Kaiser Health News - Medicare Advantage Riding High As New Insurers Flock To Sell To Seniors

By Paul Galewitz

Health care experts widely expected the Affordable Care Act to hobble Medicare Advantage, the government-funded private health plans that millions of seniors have chosen as an alternative to original Medicare.

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10/15/18 – MedPAC - MedPAC comment on CMS's proposed rule on Medicare Shared Savings Program ACOs

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10/2/18 – Kaiser Health News - Drugmakers Play The Patent Game To Lock In Prices, Block Competitors

By Sarah Jane Tribble

David Herzberg was alarmed when he heard that Richard Sackler, former chairman of opioid giant Purdue Pharma, was listed as an inventor on a new patent for an opioid addiction treatment. 
 

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10/2/18 – CHCS -  Achieving Value in Medicaid Home- and Community-Based Care: Considerations for Managed Long-Term Services and Supports Programs

By Michelle Herman Soper, Debra Lipson, Maria Dominiak, and James Lloyd

States are increasingly adopting value-based payment (VBP) models to tie payment to outcomes including quality of care, health status, and costs for their Medicaid programs. Although most Medicaid VBP models are for primary and acute care services, states are beginning to explore VBP for long-term services and supports (LTSS).

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10/2/18 – CHCS -  Rewarding Healthy Behaviors and Addressing Day-to-Day Needs: AccessHealth Spartanburg’s Gift-In-Kind Closet

Recognizing an unmet need for toiletries and household products among clients, AccessHealth Spartanburg (AHS) stocks a closet where eligible clients can “shop” for items. Clients can shop when they first enroll and at targeted intervals, plus they can earn coupons to shop for items by attending appointments, meeting with case managers, and/or achieving health-related milestones. This builds trusting relationships between clients and staff and meets basic client needs. AHS is a participant in the Transforming Complex Care initiative, a national multi-site demonstration made possible through support from the Robert Wood Johnson Foundation.

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10/1/18 – Kaiser Health News – Feds Settle Huge Whistleblower Suit Over Medicare Advantage Fraud

By Fred Schulte

One of the nation’s largest dialysis providers will pay $270 million to settle a whistleblower’s allegation that it helped Medicare Advantage insurance plans cheat the government for several years.

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10/1/18 – ICRC - Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization

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10/1/18 – CHCS - Serving Adults with Serious Mental Illness in the Program of All-Inclusive Care for the Elderly: Promising Practices

By Logan Kelly and Nancy Archibald

Program of All-Inclusive Care for the Elderly (PACE) organizations now serve a greater number of older adults with serious mental illness (SMI) than ever before, and increasingly include behavioral health providers in their care teams to meet the complex needs of this population. This brief highlights promising practices for assessment, care planning, and care coordination for older adults with SMI drawn from PACE programs, Medicare Advantage Special Needs Plans, and Medicaid plans. These approaches may be helpful for PACE programs seeking to improve or expand the delivery of behavioral health services for older adults with SMI.
 

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9/28/18 – Kaiser Family Foundation – The U.S. Government Engagement in Global Health: A Primer

Attention to global health by governments, policymakers, media, business leaders, and other institutions has increased markedly in recent decades, with a particular focus on health challenges facing low- and middle-income countries. This has led to growing funding, the establishment of new institutions and global goals, and a burgeoning community of stakeholders.

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9/28/18 – Kaiser Family Foundation – Medicaid Waiver Tracker: Which States Have Approved and Pending Section 1115 Medicaid Waivers?

Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS).

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9/21/18 – MedPAC comment on CMS's proposed rule on hospital outpatient and ambulatory surgical center payment systems for CY 2019 

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9/17/18 – Kaiser Health News – New Medicare Advantage Tool to Lower Drug Prices Puts Crimp in Patients’ Choices

By Susan Jaffe

Starting next year, Medicare Advantage plans will be able to add restrictions on expensive, injectable drugs administered by doctors to treat cancer, rheumatoid arthritis, macular degeneration and other serious diseases.

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9/13/18 – Kaiser Family Foundation - An Early Look at State Data for Medicaid Work Requirements in Arkansas

By Robin Rudowitz and MaryBeth Musumeci

Arkansas is one of four states for which CMS has approved a Section 1115 waiver to condition Medicaid eligibility on meeting work and reporting requirements and the first state to implement this type of waiver. CMS approved Arkansas’ waiver on March 5, 2018, and the new requirements took effect for the initial group of beneficiaries on June 1, 2018. The requirements are being phased in for enrollees ages 30 to 49 from June through September, 2018, and for those ages 19 to 29 in 2019. Unless exempt, enrollees must engage in 80 hours of work or other qualifying activities each month and must report their work or exemption status using an online portal. Individuals need to report work activities or exemptions by the 5th of the following month. The Arkansas Department of Human Services released data related to the new requirements in June, July and August. This brief looks at the data for August 2018 released on September 12, 2018.

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8/31/18 – MedPAC Comment on CMS’s Proposed Rule on the ESRD PPS Update for CY 2019 and DMEPOS Competitive Bidding Program

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled “Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments to Correct Existing Regulations Related to the CBP for Certain DMEPOS” in the Federal Register, vol. 83, no. 139, p. 34304–34415 (July 19, 2018). This proposed rule includes provisions that update the end-stage renal disease (ESRD) prospective payment system (PPS) for 2019, updates the payment rate for individuals with acute kidney injury (AKI) when furnished in dialysis facilities, addresses the ESRD Quality Incentive Program (QIP), and revises the DMEPOS CBP. We appreciate your staff’s ongoing efforts to administer and improve payment systems for physician and other services, particularly considering the competing demands on the agency. 

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8/23/18 – HealthIT – Request for Information for Input on EHR Reporting Program

ONC issued a request for information (RFI) for public stakeholders to share their views on the components of the EHR Reporting Program and to provide feedback that will inform the development of EHR Reporting Program criteria and processes.

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8/21/18 – Kaiser Family Foundation - Closing the Medicare Part D Coverage Gap: Trends, Recent Changes, and What’s Ahead

By Juliette Cubansk

As of 2019, Medicare beneficiaries enrolled in Part D prescription drug plans will no longer be exposed to a coverage gap, sometimes called the “donut hole”, when they fill their brand-name medications. The coverage gap was included in the initial design of the Part D drug benefit in the Medicare Modernization Act of 2003 in order to reduce the total 10-year cost of the benefit. Subsequent legislative changes are phasing out the coverage gap by modifying the share of total costs paid in the gap by Part D enrollees and plans and requiring drug manufacturers to provide a discount on the price of brand-name drugs in the gap. This data note presents trends on the Part D coverage gap and discusses recent and proposed changes affecting out-of-pocket costs for Part D enrollees who reach the coverage gap.
 
 

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8/21/18 – ASPE - Data Point – Prescription Pharmaceutical Price Changes since the Release of the President’s Drug Price Blueprint

Executive Summary - Using manufacturer-reported prescription pharmaceutical prices, we observe that the number of price increases has been reduced considerably since the release of the President’s Drug Pricing Blueprint, compared to the same time period in the year prior.
 

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8/08/18 – ASPE – An Overview of Long-Term Services and Supports and Medicaid: Final Report

By NGA T. Thach, BS and Joshua M. Wiener, PHD

ABSTRACT - This report examines the role of long-term services and supports (LTSS) in Medicaid. It also examines how sociodemographic changes are likely to affect the demand for LTSS in the future, and as a result, Medicaid use and expenditures. The report shows: the demand for LTSS is likely to increase dramatically; LTSS is a major part of the Medicaid program, accounting for about a third of total expenditures, and Medicaid is the dominant payer of LTSS.

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8/7/18 - Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization

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8/7/18 – Kaiser Family Foundation - Does Employment Lead to Improved Health? New Research Review Finds Mixed Evidence with Caveats that Could Impact Applicability to Medicaid Work Requirements

With nearly a dozen states seeking or implementing waivers to add work requirements for some Medicaid beneficiaries, a central question is whether such policies promote health and therefore promote the goals of the Medicaid program.

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Click here to view the report


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8/7/18 – Kaiser Health News – Once Its Greatest Foes, Doctors Are Embracing Single-Payer

By Shefali Luthra

When the American Medical Association — one of the nation’s most powerful health care groups — met in Chicago this June, its medical student caucus seized an opportunity for change.

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7/31/18 – CHCS – Faces of Medicaid Data Series: Examining Children’s Behavioral Health Service Use and Expenditures, 2005 - 2011

Medicaid is a significant source of funding for behavioral health care for children and youth in the United States. However, there are few national analyses examining behavioral health care being used by children in Medicaid.

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Click here to view Toolkit Overview


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7/24/18 – CHCS – The Perspective Role of Charity Care Programs in a Changing Health Care Landscape

By Matthew Ralls, Lauren Moran and Stephen A. Somers

In the post Affordable Care Act environment, charity care programs remain an important feature of the safety-net landscape in many communities, typically offering or organizing free- and reduced-cost care to individuals. Federal policy changes, such as decreased funding for navigation services, raise questions about the role charity care programs see themselves playing in the immediate future. Through support from Kaiser Permanente Community Health, the Center for Health Care Strategies recently conducted an informal survey of charity care programs across the country to explore how these programs see their role in the changing health care environment. Among the themes identified, charity care programs: (1) connect diverse populations to a wide range of human services beyond health care; (2) predict an increase demand for services through 2020; and (3) plan to rely on existing funding sources, but have concerns about funding commitments.

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7/23/18 – Kaiser Family Foundation – What do Different Data Sources Tell Us About Medicaid and Work?

A central question in the ongoing debate about imposing work requirements in Medicaid is what current work patterns are among Medicaid adults and how many so-called “able bodied” adults are not already working. Answers to these questions rely on various data sources, and characteristics of the underlying data and analytic decisions may lead to different conclusions. This data note examines what different data sources and analytic decisions tell us about Medicaid and work.

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Click here to view the data note


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7/20/18 – MedPAC – June 2018 Data Book: Health Care Spending and the Medicare Program

The MedPAC Data Book provides information on national health care and Medicare spending as well as Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care in the Medicare program, and Medicare beneficiary and other payer liability. It also examines provider settings—such as hospitals and post-acute care—and presents data on Medicare spending, beneficiaries’ access to care in the setting (measured by the number of beneficiaries using the service, number of providers, volume of services, length of stay, or through direct surveys), and the sector’s Medicare profit margins, if applicable. In addition, it covers the Medicare Advantage program and prescription drug coverage for Medicare beneficiaries, including Part D. 

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7/19/18 – The Commonwealth Fund – Has Medicare’s Bundled Payments Initiative Lowered Costs?

To help keep costs down, improve quality of care, and increase health care providers’ accountability, Medicare has been experimenting with something called bundled payments. In one model hospitals are responsible for the patient’s entire “episode of care” — the care bundle — instead of Medicare paying piecemeal for each individual service or office visit. An episode may be defined as a surgery, for example, or treatment of a chronic medical condition. If the cost of care is lower than an historical benchmark, hospitals share in the savings; if the cost is higher, hospitals are responsible for a portion of the overage.

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07/11/18 – Kaiser Family Foundation - Medigap Enrollment and Consumer Protections Vary Across States

By Cristina Boccuti, Gretchen Jacobson, Kendal Orgera, and Tricia Neuman

One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015—also known as Medigap—to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries’ access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period.

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07/11/18 – CHCS – Opportunities to Enhance Community-Based Medication Management Strategies for People with Complex Health and Social Need

By Caitlin Thomas-Henkel, Stefanie Turner and Bianca Freda

For many Americans, taking prescription medications is part of everyday life. Nearly 75 percent of the population takes at least one medication daily, and 29 percent take five or more. Despite these numbers, there is scant guidance available to help people navigate complicated drug regimens. The problem is exacerbated for individuals with multiple chronic conditions, who are often prescribed numerous drugs by various providers to be taken on different schedules — with no single entity that is coordinating all of their medications. 
 

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06/21/18 – CHCS – Community Management of Medication Complexity National Multi-Site Demonstration Launched

The Center for Health Care Strategies (CHCS) today launches the Community Management of Medication Complexity Innovation Lab, a multi-site demonstration that will identify and test community-based strategies to improve medication safety for people with complex health and social needs. This national initiative, made possible with support from the Gordon and Betty Moore Foundation and led by CHCS, will work with five competitively selected organizations to expand and enhance existing community-based medication management programs.

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06/20/18 – Kaiser Family Foundation – What’s in the Administration’s 5-Part Plan for Medicare Part D and What Would it Mean for Beneficiaries and Program Savings?

By Juliette Cubanski

Today more than 43 million older adults and people with disabilities have prescription drug coverage under Medicare Part D. Part D helps people with Medicare afford their medications by subsidizing the purchase of drug coverage from private stand-alone prescription drug plans (PDPs) and Medicare Advantage drug plans (MA-PDs), and offering additional financial help to people with low-incomes. Although premiums for Part D plans have been stable in recent years, cost-sharing requirements for drugs covered by plans have increased over time. While there have been changes to the benefit since it took effect in 2006 to enhance financial protections—in particular, phasing out the coverage gap—Part D coverage does not fully protect beneficiaries from high drug costs because the benefit does not have an annual cap on out-of-pocket spending. Enrollees who do not receive low-income subsidies are required to pay 5 percent of their total drug costs above the catastrophic coverage threshold.

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06/20/18 – Kaiser Health News – ‘Holy Cow’ Moment Changes How Montana’s State Health Plan Does Business

By Julie Appleby

Marilyn Bartlett, the director administrator of Montana’s Health Care and Benefits Division, recalls thinking “holy cow” when she got an urgent directive from state legislators in late 2014: “You have to get these costs under control, or else.”

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06/15/18 – MedPAC - Report to the Congress: Medicare and the Health Care Delivery System · June 2018

The Commission’s June 2018 report examines a variety of Medicare payment system issues. In the 10 chapters of this report, we consider: the effects of the Hospital Readmissions Reduction Program; using payment to ensure appropriate access to and use of hospital emergency department services; rebalancing Medicare’s physician fee schedule toward ambulatory evaluation and management services; paying for sequential stays in a unified prospective payment system for post-acute care; encouraging Medicare beneficiaries to use higher quality post-acute care providers; issues in Medicare’s medical device payment  policies; applying the Commission’s principles for measuring quality to population-based measures and hospital quality incentives; recent performance of and long-term issues confronting Medicare accountable care organizations; managed care plans for dual-eligible beneficiaries; and Medicare coverage policy and use of low-value care.

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Click here to view press release


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06/05/18 – Kaiser Health News - Medicare Financial Outlook Worsens

By Phil Galewitz

Medicare’s financial condition has taken a turn for the worse because of predicted higher hospital spending and lower tax revenues that fund the program, the federal government reported Tuesday.

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05/21/18 – Kaiser Family Fund - New Brief Examines Potential Effects of Public Charge Changes on Health Coverage for Citizen Children

The Trump Administration is pursuing changes that, for the first time, would allow the federal government to take into account the use of federal health, nutrition, and other non-cash public programs, including Medicaid and the Children’s Health Insurance Program (CHIP), when making a determination about whether someone is likely to be a “public charge.” Under these changes, use of these programs by an individual or a family member, including a citizen child, could result in an individual being denied lawful permanent resident status or entry into the U.S.

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05/15/18 – MedPAC - MedPAC releases March 2018 report on Medicare Payment Policy

Today, the Medicare Payment Advisory Commission (MedPAC) releases its March 2018 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in fee-for-service (FFS) Medicare and reviews the status of Medicare Advantage (MA) and the prescription drug benefit, Part D. MedPAC also recommends changing the way Medicare pays for clinician services in FFS by moving beyond the Merit-based Incentive Payment System (MIPS), recommends changes to MA and Part D to improve the equity and efficiency of those programs, and responds to a Congressional mandate on telehealth in Medicare. In the Bipartisan Budget Act of 2018, Congress enacted several policies that are similar to recommendations contained in this report.

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Click here to view the fact sheet


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05/11/18 – ASPE - Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Evaluation of Outcomes of Selected Health Home Programs, Annual Report – Year Five

by Brenda C. Spillman and Eva H. Allen

Medicaid health homes, authorized by Section 1945 of the Social Security Act, allows states to coordinate care and integrate services for Medicaid beneficiaries with multiple chronic physical, mental, or behavioral health conditions. The health home model is similar to the patient-centered medical home model, but targets high cost, high need populations and focuses on providing integrated physical, mental, and behavioral health care services, including links to nonclinical services and supports in the community. The Urban Institute, under the contract from ASPE, has conducted a five-year evaluation of the Medicaid health home option to assess the program implementation and its impacts on utilization and costs. The expectation is that improved access to integrated and coordinated primary and behavioral health care will reduce unnecessary use of costly facility-based care and result in lower spending. This fifth-year and final report presents findings from quantitative analysis of health home outcomes with respect to use of emergency room, inpatient hospital, and other facility-based care and Medicaid spending. The report also includes a brief description of the health home model and background on state programs included in the evaluation, as well as a summary of qualitative findings from previous reports.

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05/09/18 – ICRC - Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization 

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05/09/18 – Kaiser Family Foundation - Why are Healthcare Prices So High, and What can be Done about Them?

Nearly a fifth of the United States’ economy goes to healthcare spending – a far larger share than in any other large, wealthy country in the world. Research suggests that price, rather than the volume of services, is the main driver of this disparity, and price is also a primary factor in pushing up the nation’s health spending over time.
 
 

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05/09/18 – The Commonwealth Fund – 2018 Scorecard on State Health System Performance

By David C. Radley, Douglas McCarthy, and Susan L. Hayes

A state-by-state report measuring access to care, quality of care, health outcomes, and health disparities across the United States.

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05/09/18 – CHCS – AccessHealth Spartanburg: Wrap-Around Community Support for South Carolina’s Most Vulnerable Patients

In Spartanburg County, in the northern part of South Carolina, roughly 18 percent of non-elderly adults are uninsured, including a significant portion who experience multiple hardships such as poverty, chronic illness, mental health needs, poor access to primary care, and other barriers to health. Roughly one-third of Spartanburg’s most medically and socially complex patients are also caught in a coverage gap — they have too much income to be eligible for the state’s Medicaid program, but are too poor to qualify for federal health insurance subsidies available under the Affordable Care Act. When these individuals do seek care they are often in crisis, resulting in multiple and costly visits to the emergency department (ED) and frequent hospitalizations.

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04/26/18 – The Commonwealth Fund - What Commissioner Gottlieb’s FDA Is Doing to Lower Prescription Drug Prices and Steps Congress Can Take to Help

By Henry Waxman, Bill Corr, Kristi Martin, and Sophia Duong

Issue: Prescription drug prices have been climbing, creating significant barriers for patients. Since becoming U.S. Food and Drug Administration (FDA) Commissioner, Scott Gottlieb announced an action plan and several policy changes to increase generic drug competition and transparency to address high prescription drug prices.
 
Goal: This issue brief aims to explain the FDA’s plan of action and assess its implementation to date. It also aims to assess whether FDA actions, if implemented, address the known problems leading to high drug pricing.
 
Methods: We analyzed the FDA’s announced plans and actions as of March 31, 2018, and compared them to a comprehensive list of potential actions that could improve price competition among drug manufacturers included in our report, Getting to the Root of High Prescription Drug Prices: Drivers and Potential Solutions.
 

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05/08/18 – Kaiser Health News – 4 Takeaways From Trump’s Plan To Rescind CHIP Funding

By Phil Galewitz

President Donald Trump wants to employ a rarely used budget maneuver called “rescission” to eliminate $15 billion in federal spending, including $7 billion from the popular Children’s Health Insurance Program (CHIP).

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04/26/18 – Kaiser Health News – Hospitals Lure Diabetes Patients with Self-Care Courses, But Costs Can Weigh Heavily

By Julie Appleby

When a routine physical revealed mildly elevated blood-sugar levels, Michael Phillips was strongly encouraged to sign up for a diabetes self-management class.

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04/26/18 – ICRC – New and Departing Dual Eligible Special Needs Plans (D-SNPs) in Calendar Year 2018, by State 

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04/25/18 – Kaiser Health News – Peak Health Plan Premiums Give Rise to Activism – And Unconventional Solutions

By Rachel Bluth

When Garnett and Dave Mellen sent their 19-year-old daughter, Gita, off to college an hour away at Virginia Commonwealth University last fall, they didn’t expect to follow her.

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04/23/18 – Kaiser Family Foundation – Understanding Short-Term Limited Duration Health Insurance

By Karen Pollitz, Michelle Long, Ashley Semanskee, and Rabah Kamal

Short-term, limited duration (STLD) health insurance has long been offered to individuals through the non-group market and through associations.  The product was designed for people who experience a temporary gap in health coverage.1  Unlike other products that are considered “limited benefit” or “excepted benefit” policies – such as cancer-only policies or hospital indemnity policies that pay a fixed dollar benefit per inpatient stay – short-term policies are generally considered to be “major medical” coverage; however, short-term policies are distinguished from other comprehensive major medical policies because they only provide coverage for a limited term, typically less than 365 days.  Short-term policies are also characterized by other significant limitations, including the types of services covered, often with a dollar maximum.

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04/06/18 – The Commonwealth Fund – 1115 Medicaid Waivers: From Care Delivery Innovations to Work Requirements

After months of debate, the Medicaid program emerged from efforts to repeal and replace the Affordable Care Act (ACA) without major legislative changes. Now, however, the Trump administration is encouraging states to apply for waivers that place new conditions on Medicaid eligibility as well as additional costs on beneficiaries in the form of premiums and copayments at the point of service.

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04/05/18 – Kaiser Family Foundation – Analysis: Cost of Treating Opioid Addiction Rose Rapidly for Large Employers as the Number of Prescriptions Has Declined

By Cynthia Cox, Matthew Rae and Bradley Sawyer

A new Kaiser Family Foundation analysis finds that while the use of prescription opioids among people with employer-based health coverage has declined to its lowest levels in over a decade, the cost of treating addiction and overdoses has increased sharply.

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Click here to view the analysis


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03/29/18 – The Commonwealth Fund – State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting the Risk to the Individual Market

By Kevin Lucia, Justin Giovannelli, Sabrina Corlette, JoAnn Volk, Dania Palanker, Maanasa Kona, and Emily Curran

Issue: Certain forms of individual health coverage are not required to comply with the consumer protections of the Affordable Care Act (ACA). These “alternative coverage arrangements” — including transitional policies, short-term plans, health care sharing ministries, and association health plans — tend to have lower upfront costs and offer far fewer benefits than ACA-compliant insurance. While appealing to some healthy individuals, they are often unattractive, or unavailable, to people in less-than-perfect health. By leveraging their regulatory advantages to enroll healthy individuals, these alternatives to marketplace coverage may contribute to a smaller, sicker, and less stable ACA-compliant market. The Trump administration recently has acted to reduce federal barriers to these arrangements.
 
Goal: To understand how states regulate coverage arrangements that do not comply with the ACA’s individual health insurance market reforms.
 
Methods: Analysis of the applicable laws, regulations, and guidance of the 50 states and the District of Columbia.
 
Findings and Conclusions: No state’s regulatory framework fully protects the individual market from adverse selection by the alternative coverage arrangements studied. However, states have the authority to ensure a level playing field among coverage options to promote market stability.
 
 

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03/29/18 – Kaiser Health News – Scrutinizing Medicare Coverage for Physical, Occupational and Speech Therapy

By Judith Graham

For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare.

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03/28/18 – Kaiser Family Foundation – Where are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults

This fact sheet provides Medicaid and CHIP eligibility levels for children, pregnant women, parents, and other non-disabled adults as of January 2018, based on annual state survey data.1 The data highlight the central role Medicaid and CHIP play in covering low-income children and pregnant women and show Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA). See Tables 1-3 for state-specific data.

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03/22/18 – The Commonwealth Fund – Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Case – A Practical Guide to Support Health Plan and Provider Investments in Social Services

The impact of social determinants of health (SDOH) as drivers of medical utilization, cost, and health outcomes is both widely researched and acknowledged. This growing body of evidence attributes as much as 40 percent of health outcomes to SDOH such as housing, education, poverty, and nutrition and that as much as a third of the deaths in the United States can be accounted for by social factors. The influence of SDOH is particularly pronounced in vulnerable high-need, high-cost (HNHC) populations with single to multiple functional limitations.

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03/15/18 – MedPAC – Report to the Congress March 2018

The Medicare Payment Advisory Commission (MedPAC) is required by law annually to review Medicare payment policies and make recommendations to the Congress. In the March 2018 report, MedPAC makes payment policy recommendations for nine provider sectors in fee-for-service (FFS) Medicare and reviews the status of Medicare Advantage (MA) and Medicare’s prescription drug benefit (Part D). MedPAC also recommends changing the way Medicare pays for clinician services in FFS by moving beyond the Merit-based Incentive Payment System (MIPS), recommends changes to MA and Part D to improve the equity and efficiency of those programs, and responds to a Congressional mandate on telehealth in Medicare. In the Bipartisan Budget Act of
2018, Congress enacted several policies that are similar to recommendations contained in this report.
 
 

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03/14/18 – Kaiser Health News – Lifting Therapy Caps Proves a Load Off Medicare Patients’ Shoulders

By Susan Jaffe

Physical therapy helps Leon Beers, 73, get out of bed in the morning and maneuver around his home using his walker. Other treatment strengthens his throat muscles so that he can communicate and swallow food, said his sister Karen Morse. But in mid-January, his home health care agency told Morse it could no longer provide these services because he had used all his therapy benefits allowed under Medicare for the year.

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03/13/18 – Kaiser Health News – Patients Overpay for Prescriptions 23% of the Time, Analysis Shows

By Sydney Lupkin

As a health economist, Karen Van Nuys had heard that it’s sometimes cheaper to pay cash at the pharmacy counter than to put down your insurance card and pay a copay.

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03/13/18 – The Commonwealth Fund – Health Care Spending in the United States and Other High-Income Countries

By Irene Papanicolas, Liana R. Woskie and Ashish Jha

A study of why the United States spends so much more on health care than in other high-income countries concludes that higher prices — particularly for doctors and pharmaceuticals — and higher administration expenses are predominantly to blame. U.S. policy must focus on reducing these costs in order to close its spending gap with other countries.

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03/01/18 – McKnights – Congressional Opioid Efforts Targeting Medicare, Limits on New Prescriptions

By Kimberly Marselas

A bipartisan group of senators introduced legislation Tuesday that would set a three-day initial prescribing limit on opioids for acute pain and increase recovery services and availability for addicts.

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03/01/18 – Kaiser Family Foundation – The Financial Burden of Health Care Spending: Larger for Medicare Households than for Non-Medicare Households

By Juliette Cubanski, Kendal Orgera, Anthony Damico, and Tricia Neuman

Medicare offers health and financial protection to nearly 60 million adults ages 65 and over and younger people with disabilities. However, the high cost of premiums, cost-sharing requirements, and gaps in the Medicare benefit package, combined with relatively low incomes among the Medicare population, can result in beneficiaries devoting a substantial share of their total household spending to health care costs.
 

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03/01/18 – CHCS – The History, Evolution, and Future of Medicaid Accountable Care Organizations

By Rachael Matulis and Jim Lloyd

Accountable care organizations (ACOs) have become increasingly prevalent in the United States. These organizations shift more accountability for health outcomes to providers and many have shown positive results for achieving the “Triple Aim” of better health, improved patient experience, and lowered costs for Medicare, Medicaid, and commercial populations.

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Click here to view state activity map

Click here to view the fact sheet


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02/28/18 – ICRC – Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization 

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02/26/18 – The Commonwealth Fund – Income Disparities in the Prevalence, Severity, and Costs of Co-Occurring Chronic and Behavioral Health Conditions

By Peter J. Cunningham, Tiffany L. Green and Robert T. Braun

People with depression, substance abuse problems, or other behavioral health issues also often have chronic medical conditions like obesity, hypertension, or diabetes. This “co-occurring” of conditions is far more likely to befall people with low incomes than those with higher incomes. When people have both behavioral and chronic health conditions, those with low incomes spend more on their care than people with higher incomes. This disparity may reflect greater severity of disease as well as poorer access to care.

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02/23/18 – MedPAC – MedPAC Comment on CMS’s Advance Notice of Medicare Advantage Payment Policy for 2019

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS’s) December 27, 2017 “Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for the Medicare Advantage (MA) CMS–HCC Risk Adjustment Model” and the February 1, 2018 “Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 Draft Call Letter” (collectively, the Advance Notice). We appreciate your staff’s work on the notice, particularly considering the statutory requirements for changes to the risk adjustment model.
 

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02/14/18 – Kaiser Family Foundation – Analysis: Insurance Riders to Cover Abortion Services Not Available to Women in States that Restrict Abortion Coverage

In 10 states, insurance plans are currently banned from including abortion as a covered service in state-regulated private plans — all individually purchased policies and fully-insured group plans. Most of these laws do not include exceptions for rape, incest, or health endangerment. In nine of these states, insurers may sell health insurance riders for abortion coverage, but the availability of such riders has been unknown.

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Click here to view analysis


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02/13/18 – Kaiser Family Foundation – Proposed Changes to “Public Charge” Policies for Immigrants: Implications for Health Coverage

A draft version of a proposed rule by the Trump Administration would make changes to “public charge” policies that govern how use of public benefits may affect individuals’ immigration status. This fact sheet provides an overview of the proposed changes and their implications for health and health coverage.

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01/31/18 – Kaiser Health News – Expert Advice for the Corporate Titans Taking on Health Care

By KHN Staff

An announcement Tuesday by three of the nation’s corporate titans — Amazon, Berkshire Hathaway and JPMorgan Chase & Co. — that they are joining forces to address the high costs of employee health care has stirred the health policy pot. It immediately sent shock waves through the health sector of the stock market and reinvigorated talk about health care technology, value and quality.

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01/31/18 – ICRC – Program of All Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization – January 2018  

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01/31/18 – CHCS – Partnerships for Health: Lessons for Bridging Community-Based Organizations and Health Care Organizations

By Bianca Freda, Deborah Kozick and Anna Spencer

Given the impact that social factors have on health status and expenditures, and the shift toward value-based payment models that reward providers based on outcomes, health care organizations (HCO) and community based organizations (CBO) across the country are increasingly working together to address patients’ social needs. In Massachusetts, the state Medicaid agency, MassHealth, through its Medicaid 1115 demonstration waiver, is investing in accountable care organizations (ACOs) and community partners to integrate physical health, behavioral health, and long-term services and supports. The state is also funding certain approved “flexible services” that address health-related social needs that are not otherwise covered as MassHealth benefits. To inform these efforts, it is important to examine the strategic, operational, and financial approaches that drive the success of HCO and CBO partnerships. This brief draws on insights gleaned from the Robert Wood Johnson Foundation’s (RWJF) Partnership for Healthy Outcomes project and the Blue Cross Blue Shield of Massachusetts Foundation (BCBSMA Foundation) June 2017 conference, which convened several HCO-CBO partnerships to share promising partnership models. It outlines characteristics of successful HCO-CBO partnerships and provides recommendations to guide the development of successful collaborations between health care and social service organizations.
 

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01/31/18 – The Commonwealth Fund – Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools 

By Deborah Bachrach, Jocelyn Guyer, Sarah Meier, John Meerschaert, and Shelly Brandel

Issue: It is widely recognized that social factors, such as unstable housing and lack of healthy food, have a substantial impact on health outcomes and spending, particularly with respect to lower-income populations. For Medicaid, now dominated by managed care, this raises the question of how states can establish managed care rates to sustain investments in social supports.
 
Goal: To explore practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues.
 
Methods: Literature review, interviews with stakeholders, and analysis of federal regulations.
 
Findings and Conclusions: We identify the following options: 1) classify certain social services as covered benefits under the state’s Medicaid plan; 2) explore the additional flexibility afforded states through Section 1115 waivers; 3) use value-based payments to support provider investment in social interventions; 4) use incentives and withholds to encourage plan investment in social interventions; 5) integrate efforts to address social issues into quality improvement activities; and 6) reward plans through higher rates for effective investments in social interventions. More needs to be done, however, to assist interested states in using these options and identifying pathways to braid Medicaid dollars with other social services funding.
 

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01/02/18 – Program of All-Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization  

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12/22/17 – The United States Department of Justice – Kmart Corporation to Pay U.S. $32.3 Million to Resolve False Claims Act Allegations for Overbilling Federal Health Programs for Generic Prescription Drugs

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation (SHC), has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, the health program for uniformed service members and their families, the Justice Department announced today.

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12/21/17 – The Commonwealth Fund – Do Medicare Advantage Plans Minimize Costs? Investigating the Relationship Between Benchmarks, Costs, and Rebates

By Stephen Zuckerman, Laura Skopec and Stuart Guterman

Issue: Medicare Advantage (MA), the program that allows people to receive their Medicare benefits through private health plans, uses a benchmark-and-bidding system to induce plans to provide benefits at lower costs. However, prior research suggests medical costs, profits, and other plan costs are not as low under this system as they might otherwise be.
 
Goal: To examine how well the current system encourages MA plans to bid their lowest cost by examining the relationship between costs and bonuses (rebates) and the benchmarks Medicare uses in determining plan payments.
 
Methods: Regression analysis using 2015 data for HMO and local PPO plans.
 
Findings: Costs and rebates are higher for MA plans in areas with higher benchmarks, and plan costs vary less than benchmarks do. A one-dollar increase in benchmarks is associated with 32-cent-higher plan costs and a 52-cent-higher rebate, even when controlling for market and plan factors that can affect costs. This suggests the current benchmark-and-bidding system allows plans to bid higher than local input prices and other market conditions would seem to warrant.
 
Conclusion: To incentivize MA plans to maximize efficiency and minimize costs, Medicare could change the way benchmarks are set or used.
 

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12/07/17 – ICRC – Spotlight: Additional Detail on Selected CMS Proposed Changes for Medicare Advantage and the Prescription Drug Benefit Program

This Spotlight is a follow-up to the November 22 ICRC e-alert on the Centers for Medicare & Medicaid Services (CMS)’ proposed policy changes and updates for Medicare Advantage (MA) and the Part D prescription drug benefit. In this Spotlight, ICRC presents a more detailed description of some of the proposed changes that may be of special interest to states planning or operating integrated programs for dually eligible Medicare-Medicaid enrollees under the capitated model of the Financial Alignment Initiative and through contracts with Dual Eligible Special Needs Plans (D-SNPs).

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12/6/17 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, November 2016 to November 2017

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12/6/17 – ICRC – Program of All Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization 

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12/5/17 – CHCS – Medicaid ACOs: State Activity Map

State-based Medicaid accountable care organizations (ACOs) are becoming increasingly prevalent across the country, with more and more states pursuing ACOs as a way to improve health outcomes and control costs through greater provider accountability. This interactive map offers an ongoing update of Medicaid ACO activities by state, including governance structure, scope of services, and payment model.

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12/4/17 – The Commonwealth Fund – The Big Five Health Insurers’ Membership and Revenue Trends: Implications for Public Policy

By Cathy Schoen and Sara R. Collins

The five largest U.S. commercial health insurers collectively cover more than two-fifths of the insured population. Over the past decade, these companies’ bottom lines have become increasingly linked to Medicare and Medicaid, with the two programs accounting for 59 percent of revenues in 2016. Access to coverage could be improved if insurers that participate in Medicaid or Medicare were required to also participate in the marketplaces in the same geographic area.

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Click here to view the press release

Click here to view the appendix


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11/21/17 – CMCS – Nationwide Adult Medicaid CAHPS – Analytic Brief – November 2017

Health Care Experiences of Adults with Disabilities Enrolled in Medicaid Only: Findings from a 2014-2015 Nationwide Survey of Medicaid Beneficiaries

Persons who qualify for Medicaid on the basis of a disability are a diverse population group, consisting of individuals with a wide range of physical impairments, functional limitations, and intellectual and mental health disabilities. In 2015, Medicaid provided coverage for 10.2 million non-elderly individuals on the basis of a disability. Most of those individuals were adults ages 18 and older residing in a community setting. Medicaid beneficiaries with a disability may be enrolled in Medicaid alone or be dually enrolled in Medicaid and Medicare. This brief focuses on adult Medicaid beneficiaries who are not dually enrolled and qualified for Medicaid on the basis of a disability.
 
 

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11/21/17 – Kaiser Health News - Massachusetts Grabs Spotlight By Proposing New Twist on Medicaid Drug Coverage

By Shefali Luthra

In the absence of new federal policies to tame break-the-bank drug prices, Massachusetts’ state Medicaid program hopes to road-test an idea both radical and market-driven. It wants the power to negotiate discounts for the drugs it purchases and to exclude drugs with limited treatment value.

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11/15/17 – The Commonwealth Fund – Older Americans Were Sicker and Faced More Financial Barriers to Health Care Than Counterparts in Other Countries

2017 Commonwealth Fund International Health Policy Survey of Older Adults

By Robin Osborn, Michelle M. Doty, Donald Moulds, Dana O. Sarnak, and Arnav Shah

An international survey of older adults finds that seniors in the United States are sicker than their counterparts in 10 other high-income countries and face greater financial barriers to health care, despite the universal coverage that Medicare provides. Across all the countries, few elderly adults discuss mental health concerns with their primary care providers. Moreover, nearly a quarter are considered “high need” — meaning they have three or more chronic conditions or require help with basic tasks of daily living.

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Click here to view the press release


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ICRC – Value-Based Payment in Nursing Facilities: Options and Lessons for States and Managed Care Plans

By Jenna Libersky, Julie Stone, Leah Smith, James Verdier, and Debra Lipson

To improve the value of care provided in nursing facilities, payers are experimenting with value-based payment (VBP) approaches that link financial rewards to measures of quality. Drawing on findings from interviews with state officials and plan representatives, this brief describes the VBP approaches that select states and managed care plans currently use, presents perceived effects of VBP, and shares lessons on the design and administration of VBP programs. States interested in VBP may look to the examples in the brief to design their own VBP programs or encourage plans to do so.

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10/26/2017 – Avalere – Impact Evaluation: Medicare Advantage Transition from RAPS to EDS

By Christie Teigland

In February 2017, Avalere, an Inovalon company, analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
 
 

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10/25/2017 – Kaiser Family Foundation – Data Note: Public’s Views of a National Health Plan

By Ashley Kirzinger, Liz Hamel, Bianca DiJulio, Cailey Munana, and Mollyann Brodie

The October Kaiser Health Tracking Survey continues our efforts to track attitudes towards a national health plan, sometimes referred to as a “single-payer plan” or “Medicare-for-all,” in which all Americans would get health insurance from a single government plan. About half of the public (53 percent) favor having a national health plan, while 44 percent oppose such a plan. Support for such a proposal is largely driven by Democrats with three-fourths (73 percent) favoring such a plan, of which nearly half (46 percent) say they “strongly favor” it. On the other hand, seven in ten (71 percent) Republicans oppose such a plan, including more than half (55 percent) of Republicans who say they “strongly oppose” it. Independents are more divided with a slightly larger share favoring a national health plan than opposing it (55 percent vs. 43 percent).

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Click here to view Topline & Methodology


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10/23/2017 – CHCS – Virginia Commonwealth University Health System: Beyond the Walls and Into Communities

Using Outreach Workers to Extend Complex Care into High-Opportunity Neighborhoods – In late September 2016, Briana Ricks, an outreach worker employed by Virginia Commonwealth University Health System’s (VCU Health) Complex Care Clinic (CCC) in Richmond, met with a new patient who had been admitted to the hospital for the fifth time that month. Struggling with diabetes, chronic obstructive pulmonary disease (COPD), hypertension, and a history of substance use, the woman was being hospitalized frequently due to fluid build-up in her lungs.

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10/19/2017 – AHIP – Health Plans Launch New STOP Initiative to Help Battle Opioid Crisis in America

By Cathryn Donaldson

Health plans nationwide are working closely with state and federal leaders, as well as with physicians and other providers on multiple strategies to address the opioid crisis. To build on these efforts, America’s Health Insurance Plans (AHIP) has launched its Safe, Transparent Opioid Prescribing (STOP) Initiative. The STOP Initiative is designed to support widespread adoption of clinical guidelines for pain care and opioid prescribing.
 
 

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10/18/2017 – The Commonwealth Fund – How Well Does Insurance Coverage Protect Consumers from Health Care Costs?

Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016

By Sara R. Collins, Munira Z. Gunja and Michelle M. Doty

Issue: The United States has made historic progress on insurance coverage since the Affordable Care Act became law in 2010, with 20 million fewer people uninsured. However, we must also measure progress by assessing how well people who have insurance from all coverage sources are protected from high health care costs.
Goals: To estimate the number and share of U.S. insured adults who are “underinsured” or have out-of-pocket costs and deductibles that are high relative to their incomes.
 
Method: Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 2003–2016.
 
Findings: As of late 2016, 28 percent of U.S. adults ages 19 to 64 who were insured all year were underinsured — or an estimated 41 million people. This is more than double the rate in 2003 when the measure was first introduced in the survey, and is up significantly from 23 percent, or 31 million people, in 2014. Rates climbed across most coverage sources, and, among privately insured, were highest among people with individual market coverage, most of whom have plans through the marketplaces. Half (52%) of underinsured adults reported problems with medical bills or debt and more than two of five (45%) reported not getting needed care because of cost.
 
 
 
 

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10/12/2017 – CHCS – Bridging Community-Based Human Services and Health Care Case Study Series

Given the importance of social factors in influencing health and wellbeing, health care organizations and community-based organizations (CBOs) across the country are increasingly interested in working together in new ways to address social needs that may be contributing to poor health outcomes and unnecessary costs. As these cross-sector relationships emerge, there is much to learn about these innovative partnership models as well as the strategic, cultural, operational, and financial approaches that drive their success.

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10/05/2017 – Avalere- CMS Proposal for New Medicare Payment System Could Lead to Late Payment Variability for Specialists

New Analysis from Avalere Finds that Payments to Certain Physician Specialists Could Increase or Decrease by as Much as 16% for Their 2018 Performance Under the Merit-Based Incentive Payment Program (MIPS)

By John Feore and Richard Kane

The adjustments could take effect if the Centers for Medicare & Medicaid Services (CMS) finalizes a proposal to change how payments to clinicians are calculated under MIPS. For most types of physicians, these payment adjustments would only range between +/- 5%, as provided for under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
 

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09/28/2017 – Kaiser Health News – Why Glaring Quality Gaps Among Nursing Homes are Likely to Grow if Medicaid is Cut

By Jordan Rau

Nursing homes that rely the most on Medicaid tend to provide the worst care for their residents — not just the people covered by the program but also those who pay privately or have Medicare coverage.

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09/27/2017 – NAHC – Two Wins in One Day! Senate Passes CHRONIC Care Act and RAISE Family Caregivers Act

Home care and hospice won a double victory yesterday, September 26, when the United States Senate passed the CHRONIC Care Act and the RAISE Family Caregivers Act. Both pieces of legislation are important to the home care and hospice community and the millions of Americans who depend on it. NAHC worked hard to ensure passage of the legislation in the Senate and we will be working hard to get the legislation moved forward in the House of Representatives.

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09/27/2017 – CHCS – Financing Project ECHO: Options for State Medicaid Programs

By Greg Howe, Allison Hamblin, and Lauren Moran, Center for Health Care Strategies

Project ECHO®, a unique model for expanding access to specialty health care services, can bolster state Medicaid program efforts to improve care in underserved areas. With a handful of states using Medicaid funds to support Project ECHO, more states are interested in pursuing ECHO models to enhance services for at-risk populations. This brief outlines an array of financing options, including approaches currently in use as well as new options, and highlights how four states — California, Colorado, New Mexico, and Oregon — leveraged Medicaid support for ECHO. It outlines design considerations for specific delivery system environments as well as broad considerations for long-term sustainability of Project ECHO approaches. This brief is a product of the Project ECHO Medicaid Learning Collaborative made possible with support from the Leona M. and Harry B. Helmsley Charitable Trust and the GE Foundation.

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Click here to view the Medicare Financing Models for Project ECHO

Click here to view fact sheet


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09/26/2017 – NAHC – NAHC Files Comments with CMS on Home Health Prospective Payment System Rate Update and More

The National Association for Home Care & Hospice (NAHC) filed comments on Tuesday, September 25, 2017, with the Centers for Medicare & Medicaid Services (CMS) on the CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements.

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09/26/2017 – The Commonwealth Fund – Intensive Outpatient Care Program: A Care Model for the Medically Complex Piloted by Employers

By Kristof Stremikis, Clare Connors, and Emma Hoo

Improving care for high-need, high-cost patients has long been a priority for both public and private sector purchasers of health care. In 2009, the Pacific Business Group on Health (PBGH) partnered with Boeing to implement a care management initiative that Boeing had successfully piloted with about 700 of its employees, retirees, and dependents. Called the Intensive Outpatient Care Program (IOCP),1 the initiative aims to improve outcomes for medically complex patients and prevent unnecessary hospital use by providing care coordination, self-management support, and effective ambulatory care. The overall goal of IOCP is to keep participants at home and in their communities by providing intensive, person-centered outpatient care.

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09/22/2017 – MedPAC – MedPAC Comment on CMS’s Proposed Rule on the CY 2018 Home Health Prospective Payment System

The Medicare Payment Advisory Commission (MedPAC) appreciates the opportunity to submit comments on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled “Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements,” Federal Register, Vol. 82, No. 144, p. 35270 (July 28, 2017). We appreciate your staff’s efforts to administer and improve the Medicare payment system for home health agencies (HHAs), particularly given the competing demands on the agency.

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09/19/2017 – The Commonwealth Fund – Extending the Children’s Health Insurance Program: High Stakes for Families and States

By Sara Rosenbaum, Rachel Gunsalus, Sara Rothenberg and Sara Schmucker

Congress must decide whether to extend federal funding authority for the Children’s Health Insurance Program (CHIP), which ends September 30, 2017. CHIP operates much like Medicaid, providing federal matching payments for state program expenses, although CHIP’s funding rate is higher than the federal rate paid for traditional Medicaid and was further enhanced under the Affordable Care Act. States can use their CHIP funds to expand Medicaid, operate separate CHIP programs, or combine the two approaches. Today CHIP covers 8.4 million children and provides maternity coverage for approximately 370,000 women.

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09/18/2017 – Avalere – Exchange Reinsurance Stabilization Package Could Reduce 2018 Premiums by 17%

Market Stabilization Efforts Could Also Lead to Higher Enrollment in Exchanges

By Chris Sloan and Elizabeth Carpenter

Funding a $15 billion reinsurance stabilization package, in combination with a delay of the Affordable Care Act’s (ACA’s) health insurance tax (HIT) through the end of 2018 and guaranteeing funding of cost-sharing reductions (CSRs), could reduce average yearly premiums by $1,363 (a 17% reduction), according to new research from Avalere. Uncertainty in the individual market, rising premiums, and declining issuer participation have created the need for federal and state policy makers to address these issues to stabilize the marketplace.

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09/11/2017 – The Commonwealth Fund – The HITECH Era and the Path Forward

By David Blumenthal, Vindell Washington, Karen DeSalvo, and Farzad Mostashari

In 2004, President George W. Bush established the Office of the National Coordinator for Health Information Technology (ONC) to help bring the health care sector into the digital age. Then, in 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act to spur greater action on digitizing health and moving away from the waste and errors associated with a paper-based health system.

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09/06/2017 – Kaiser Family Foundation - Current Status of State Planning for the Future of CHIP

Federal funding for the Children’s Health Insurance Program (CHIP), which covered 8.9 million children in FY 2016, is set to expire on September 30, 2017. This fact sheet provides an overview of current state plans for CHIP amid continuing uncertainty about future federal funding for the program and discusses how states and children would be affected if Congress does not extend funding by the September 30, 2017 deadline. With this deadline nearing, states will need to begin making decisions soon about actions they will take if Congress does not extend funding. States provide CHIP through a separate CHIP program, a CHIP-funded Medicaid expansion, or a combination of both approaches. States with CHIP-funded Medicaid expansions would be required to maintain this coverage under the Affordable Care Act (ACA) maintenance of effort requirement, and state costs would increase since states would receive the lower federal Medicaid match rate. States with separate CHIP coverage would not be required to maintain this coverage if federal funding ends.

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09/06/2017 – The Commonwealth Fund - Insurer Market Power Lowers Prices in Numerous Concentrated Provider Markets

By Richard M. Scheffler and Daniel R. Arnold

Health care providers and insurers have each increased their market power by consolidating in recent years. Researchers found that this consolidation has implications for negotiations between providers and insurers. Specifically, they found that in markets where both providers and insurers are highly concentrated, insurers have bargaining power to reduce prices for hospital admissions and visits to certain physician specialists. While insurers are able to bargain for reduced prices, there is little evidence that these savings will be passed on to consumers through lower premiums.

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08/31/2017 – CHCS – Design Considerations for Nursing Facility Quality Improvement Initiatives in Medicaid Managed Long-Term Services and Supports Programs

By Ann Mary Philip and Stephanie Gibbs

Nursing facilities are an essential part of most Medicaid managed long-term services and supports (MLTSS) programs. Improving the quality of care provided by nursing facilities is a goal for states, managed care organizations, nursing facility providers, and facility residents and their families.
 
This brief, developed with support from the Robert Wood Johnson Foundation, examines four key considerations for states developing nursing facility quality improvement initiatives: (1) using existing data sources when possible to reduce provider burden; (2) enlisting the help of internal or external quality measurement experts; (3) seeking stakeholder engagement and support; and (4) understanding how the initiative may influence beneficiary protections and access to care.
 

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08/03/2017 – Kaiser Family Foundation - Health Plan Enrollment in the Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries

As of July 2017, nearly 400,000 beneficiaries who are dually eligible for Medicare and Medicaid were enrolled and receiving services from health plans in 10 states with capitated financial alignment demonstrations. These demonstrations, jointly managed by the Centers for Medicare and Medicaid Services (CMS) and the participating states, seek to maintain or decrease costs while maintaining or improving health outcomes for this vulnerable population of seniors and non-elderly people with disabilities. This fact sheet provides a snapshot of enrollment in the demonstrations by state, as of July 2017.

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08/02/2017 – The Kaiser Family Foundation - Many More Counties Lack Medicare Advantage Plans Today than are at Risk for Lacking an ACA Marketplace Insurer in 2018

A new analysis from the Kaiser Family Foundation finds that 147 counties lack Medicare Advantage plans – many more than the 19 counties expected to lack an Affordable Care Act (ACA) marketplace insurer next year. Yet Medicare Advantage, the private plans that cover a third of all Medicare beneficiaries, is often described as an example of a robust insurance market, while some policymakers say the “bare” counties under the ACA are evidence that the law is failing.

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Click here to view the issue brief


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07/20/2017 – Forbes - UnitedHealth Group Predicts 50% Of Seniors Will Choose Medicare Advantage

By Bruce Japsen

Medicare Advantage plans could quickly become the choice of one in two seniors as millions flock to privately administered health benefits for the government’s health insurance for elderly Americans, the nation’s largest health insurer is predicting.

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07/20/2017 – McKnight’s - Observers Skeptical Of House Republicans' Call To Cut $2 Trillion In Medicaid, Medicare

By Emily Mongan

A budget plan released Tuesday by House Republicans would cut close to $2 trillion from federal healthcare programs — but it's unlikely to get very far in the legislative process, observers say.  The House's Fiscal Year 2018 budget blueprint, dubbed “Building a Better America,” would reportedly achieve a $6.5 trillion deficit reduction over the next decade.

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Click here to view the FY 2018 budget blueprint


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07/19/2017 – Avalere - New Medicare Incentives Encourage Accountable Care Organizations To Assume Greater Risk

By Josh Seidman, John Feore, and Biruk Bekele

New research from Avalere finds that accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) would have earned an additional net payments of $886 million in 2015 if they had assumed greater financial risk under the program and had qualified for the 5 percent bonus payment now available under the Quality Payment Program (QPP).

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07/18/2017 – Kaiser Family Foundation - The Facts on Medicare Spending and Financing

By Juliette Cubanski and Tricia Neuman

Medicare, the federal health insurance program for 57 million people ages 65 and over and younger people with permanent disabilities, helps to pay for hospital and physician visits, prescription drugs, and other acute and post-acute care services. In 2016, spending on Medicare accounted for 15 percent of the federal budget (Figure 1). Medicare plays a major role in the health care system, accounting for 20 percent of total national health spending in 2015, 29 percent of spending on retail sales of prescription drugs, 25 percent of spending on hospital care, and 23 percent of spending on physician services.1 This issue brief includes the most recent historical and projected Medicare spending data published in the 2017 annual report of the Boards of Medicare Trustees from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary (OACT) and the 2017 Medicare baseline and projections from the Congressional Budget Office (CBO).
 
 

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07/17/2017 – McKnight’s - CMS Proposes Medicare Coverage For Outpatient Joint Replacements, Changes To SNF 3-Day Stay Rule

By Emily Mongan

The Centers for Medicare & Medicaid Services released two proposals last week that may change where beneficiaries receive joint replacements, and how accountable care organizations deal with the agency's three-day stay rule waiver.

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07/14/2017 – The Commonwealth Fund - New 11-Country Study: U.S. Health Care System Has Widest Gap Between People With Higher And Lower Incomes

New International Ranking Underscores the Importance of Health Insurance Coverage and Strong Primary Care

Your level of income defines the health care you receive far more in the United States than in other wealthy nations, according to the Commonwealth Fund’s new 11-country report. The study, the only to include survey data to measure and compare patient and physician experiences across wealthy nations, ranks the U.S. last overall, and on providing equally accessible and high-quality health care, regardless of a person’s income. For example, in the United Kingdom, 7 percent of people with lower incomes and 4 percent with higher incomes reported that costs prevented them from getting needed health care—a three percentage point gap between those with higher and lower incomes. In the U.S., 44 percent of lower income and 26 percent of higher income people reported financial barriers to care. Remarkably, a high-income person in the U.S. was more likely to report financial barriers than a low-income person in the U.K.
 
 
 
 
 

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07/10/2016 – CHCS - Working Together Toward Better Health Outcomes

By Elise Miller, Trishna Nath, and Laura Line

With rising costs, persistent health inequities, and gaps in care access, there is a heightened focus across sectors on new approaches to achieve better health outcomes. Policy and industry practices are shifting to prioritize value over volume. New payment and delivery models, and value-based contracting are aiming to reduce costs while improving patient care and community health. In addition, a broadening recognition of the critical role of the social determinants of health is forging increasingly common ground for providers of healthcare and human services.

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07/10/2017 – The Commonwealth Fund -Getting to the Root of High Prescription Drug Prices

By Henry Waxman, Bill Corr, Kristi Martin, and Sophia Duong

Historic increases in prescription drug prices and spending are contributing to unsustainable health care costs in the United States. While rising prescription drug utilization is clearly a product of population growth, an aging population, and greater use of drugs in health care among all age groups, about one-third of the rise in prescription spending from 2010 to 2014 was a result of either price increases for drugs or a shift in prescribing toward higher-price products. Caught in the middle are patients. Faced with rising drug costs, too many must choose between taking life-saving drugs or paying the rent. And many Americans are concerned about how they will afford their medications in the future.

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Click here to view the report


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06/15/2017 – MedPAC - Medicare Payment Advisory Commission Releases Report On Medicare And The Health Care Delivery System

Today the Medicare Payment Advisory Commission (MedPAC) releases its June 2017 Report to the Congress: Medicare and the Health Care Delivery System. As part of its mandate from the Congress, each June MedPAC reports on issues affecting the Medicare program as well as broader changes in health care delivery and the market for health care services.

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Click here to read the fact sheet

Click here to read the full report


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06/13/2017 – Kaiser Family Foundation - Testimony: Promoting Integrated and Coordinated Care for Medicare Beneficiaries

By Gretchen A. Jacobson, Ph.D.

Gretchen Jacobson, Associate Director of the Foundation’s Program on Medicare Policy, testified on June 7, 2017 before the U.S. House Committee on Ways and Means, Subcommittee on Health as part of the Committee’s hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries. Her testimony focused on the challenges and opportunities presented by three approaches for integrating and coordinating care for high-cost, high-need Medicare beneficiaries, many of whom are dually eligible for Medicare and Medicaid. These approaches included Medicare Advantage Special Needs Plans (SNPs), the Program of All-Inclusive Care for the Elderly (PACE), and value-based insurance design (VBID) for beneficiaries who choose to enroll in Medicare Advantage plans.

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06/08/2017 – Kaiser Family Foundation - Medicaid’s Role for Seniors

There are 47.5 million Americans age 65 and older, making up 15% of the population, as of 2015.  Many have complex physical and behavioral health care needs, such as heart disease, diabetes, and dementia.  Seniors often require services that are not covered by Medicare, such as long-term care.  There include assistance with self-care, such as bathing and dressing, and household activities, such as preparing meals and housekeeping.  

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06/06/2017 – Kaiser Family Foundation - Medicare Advantage 2017 Spotlight: Enrollment Market Update

By Gretchen Jacobson, Anthony Damico, Tricia Neuman, and Marsha Gold

Medicare Advantage plans have played an increasingly larger role in the Medicare program as the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade.  The trend in enrollment growth is continuing in 2017, and has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA).  This Data Spotlight reviews national and state-level Medicare Advantage enrollment trends as of March 2017 and examines variations in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, and quality ratings.

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05/31/2017 – McKnight’s - Senators Push To Preserve Funding For Medicare Assistance Program

By Emily Mongan

Lawmakers called on Congress last week to continue funding a program that helps beneficiaries navigate Medicare, following the administration's fiscal year 2018 budget proposing to cut it entirely.  The State Health Insurance Assistance Program, which provides counselors to Medicare beneficiaries to help with enrollment, choosing plans and appealing coverage denials, found itself on the chopping block for the second time in a year under last week's budget plan.

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Click here to read the letter


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05/31/2017 – The Commonwealth Fund - International Profiles of Health Care Systems

Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States

By Elias Mossialos, Ana Djordjevic, Robin Osborn, and Dana Sarnak

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.

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05/18/2017 – MedPAC – Testimony: Report to the Congress: Medicare Payment Policy (Ways and Means)

By law, the Medicare Payment Advisory Commission reports to the Congress each March on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). In this year’s report, we consider the context of the Medicare program in terms of the effects of its spending on the federal budget and its share of national gross domestic product (GDP).

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05/12/2017 – The Commonwealth Fund - Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status

By Cathy Schoen, Karen Davis, and Amber Willink

For more than 50 years, Medicare has been a stable, trusted source of health insurance that provides basic access and financial protection for elderly and disabled beneficiaries for acute hospital and medical care services. The program has directly contributed to sharp declines in mortality and longer life expectancy for those age 65 and older. It also has succeeded in holding spending per beneficiary nearly flat over the past five years, below private insurance increases.

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Click here to view the Appendices

Click here to view the chartpack


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05/09/2017 – Avalere - Medicare Advantage Patients Less Likely to Use Post-Acute Care

By Fred Bentley and Erica Breese

Specifically, 77 percent of MA patients are sent directly home (without home health) following a hospital stay compared to 63 percent of FFS patients (Figure 1). While there are many factors that could influence the variation in post-acute care use, Avalere’s findings point to potential differences in how MA plans manage their beneficiaries’ care.

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05/02/2017 – Kaiser Family Foundation - Brief Examines Per Enrollee Medicaid Spending for Seniors and People with Disabilities, Which Varies Greatly By State

Medicaid coverage of acute and long-term care for more than 6 million low-income seniors and 10 million nonelderly people with disabilities accounts for nearly two-thirds of overall Medicaid spending, although such enrollees represent less than a quarter of people on Medicaid.  Much of Medicaid’s spending on seniors and people with disabilities also depends on state decisions about whom to cover and which services to pay for, which is a big reason why Medicaid spending per enrollee for these populations varies greatly from state to state.

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Click here to view the Issue Brief


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04/21/2017 – Kaiser Family Foundation - Income and Assets of Medicare Beneficiaries, 2016-2035

By Gretchen Jacobson, Shannon Griffin, Tricia Neuman, and Karen Smith

Many Medicare beneficiaries, including seniors and younger adults with disabilities, live on fixed incomes supplemented by the savings they accumulated during their working years.  Their income and accumulation of savings is tied to many life experiences, including their education, health status, marital status, number of work years, household income, periods of unemployment, investments, years of homeownership, access to employer retirement benefits, inheritance, other financial supports, and various economic factors.  As a result, the income and assets of Medicare beneficiaries vary greatly. 

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04/19/2017 – GAO – Medicaid Program Integrity: CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States

Medicaid remains a high-risk program, partly due to concerns about improper payments. CMS oversees and supports states, in part, by reviewing their program integrity activities, hiring contractors to audit providers, and providing training. In recent years, CMS made changes to its Medicaid program integrity efforts, including a shift to collaborative audits.

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03/20/2017 – MACPAC - March 2017 Report to Congress on Medicaid and CHIP

In the March 2017 Report to Congress on Medicaid and CHIP, MACPAC addresses three functions central to the roles of Medicaid and the State Children’s Health Insurance Program (CHIP) as the source of coverage for almost 90 million people:
providing health insurance for children,
making payments to safety-net hospitals, and
monitoring access to care under managed care and fee for service (FFS).
 
 

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03/15/2017 – MedPAC - Medicare Payment Advisory Commission Releases Report On Medicare Payment Policy

The Medicare Payment Advisory Commission (MedPAC) releases its March 2017 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in fee-for-service (FFS) Medicare and provides a review of Medicare Advantage (MA) and the prescription drug benefit, Part D.

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Click here to view the fact sheet

Click here to view the complete report


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