« The Dual Agenda: January 27, 2016 Issue

Noteworthy News

Evaluation Information on Dual Eligible Demonstrations Begins to Emerge

After a long wait, the Centers for Medicare and Medicaid Services (CMS) has begun releasing evaluation information on the dual eligible demonstration projects. One CMS evaluation report provides results from the first year of the Washington state Fee-for-Service demonstration, which is focused on improving care coordination through the use of Health Homes. The evaluation shows promising early results both in terms of enrollment as well as savings. Simultaneously, an evaluation report was released on the early implementation experience of demonstrations in California, Illinois, Massachusetts, Minnesota, Ohio, Virginia and Washington. This report describes many challenges, most of which are consistent with those raised by consumer advocates over the past two years. State-specific annual reports for Massachusetts, Washington and Minnesota are scheduled to be released later in 2016.

In related news, the Government Accountability Office (GAO) released a report that examined how health plans participating in the dual eligible demonstrations are implementing care coordination, what challenges they have encountered and how CMS oversees care coordination activities. The GAO found a variety of challenges in implementing this key aspect of improving care for dual eligible beneficiaries and, as a result, recommended that CMS strengthen oversight of care coordination in the demonstrations.

CMS Announces Expansion of Medicare ACO Program

In January, CMS announced a major expansion of its experiment with Accountable Care Organizations (ACOs) in the Medicare program. 121 ACOs will be added, bringing the total nationwide to 477. An estimated 8.9 million seniors will be receiving care through an ACO once this expansion is complete. ACOs are charged with improving quality of care and lowering costs. Part of their payment from Medicare is based on how well they meet these goals.

Creating a Person-Centered Culture of Care

Community Catalyst published a new blog post on person-centered health care as part of its blog series on health system transformation. To improve care and reduce costs, our health care system must better integrate physical and behavioral health care with community-based supports and services. Core components of this kind of care include comprehensive health assessments, incorporation of patient preferences into the care plan, seamless care transitions and culturally- competent care teams.

CMS Releases Guide to Preventing Readmissions Among Racially and Ethnically Diverse Medicare Beneficiaries

The Centers for Medicare and Medicaid Services Office of Minority Health (CMS OMH) released a new Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries. The guide was developed in collaboration with the Disparities Solutions Center at Massachusetts General Hospital and the National Opinion Research Center (NORC) at the University of Chicago as part of the CMS Equity Plan for Improving Quality in Medicare. Designed to assist hospital leaders and stakeholders focused on quality, safety and care redesign in identifying root causes and solutions for preventing avoidable readmissions, the guide offers high-level recommendations as well as case studies of successful interventions.

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