« The Dual Agenda: March 23, 2016 Issue

State Highlights

California

The Department of Health Care Services has released a new dashboard containing performance data on how health plans participating in Cal MediConnect, the state’s dual eligible demonstration project, are performing in six areas related to care coordination, quality and service utilization. The metrics in this dashboard are: 1) health risk assessments, 2) appeals by determination, 3) hospital discharge, 4) emergency utilization, 5) long-term services and supports (LTSS) utilization and 6) case management.

In other news, California’s Office of the Patient Advocate recently expanded the Medical Group Report Card for large physician groups so consumers may now compare cost in addition to quality ratings, to help them get details on health care prices.

Maryland

Researchers at the Hilltop Institute at the University of Maryland, Baltimore County have analyzed Maryland’s 2012 Medicare and Medicaid data. Among their findings is that more than one-third of the state’s dually eligible individuals had at least one claim with a mental health diagnosis. The analysis was part of a series of studies that Maryland will use to develop a strategy to integrate care for the state’s dually eligible population.

Massachusetts

On March 10, MassHealth, the state’s Medicaid program, held a public meeting to discuss the overall direction and timeline for its care delivery and payment reforms. The state intends to release a draft waiver proposal for public comment in late April. It is expected that this proposal will include plans to shift MassHealth beneficiaries into Accountable Care Organizations (ACOs). The waiver would also seek approval to implement a Delivery System Reform Incentive Payment (DSRIP) program. This would allow the state to use federal Medicaid funding to support ACOs, community partners and statewide infrastructure.

In dual eligible demonstration project news, MassHealth has posted the February enrollment report for the One Care project. The One Care Implementation Council met on March 18 and agenda items included a presentation on the barriers to health care for people who are chronically homeless and an update from the One Care Ombudsman.

Finally, the Service Employees International Union is pushing a controversial ballot question that will take hundreds of millions of dollars from the state’s wealthiest hospitals and spread those dollars among lower-paid community hospitals. While the Massachusetts Hospital Association (MHA) strongly opposes the measure, Steward Health Care, which owns nine hospitals in the state (and is not a member of the MHA), has broken ranks with other hospitals and is supporting the question. Price disparities among Massachusetts’ hospitals have been a long-simmering issue in the state, and the ballot question is shaping up to be an expensive and heated political battle in November.

Michigan

The Centers for Medicare and Medicaid Services has released its revised Michigan-specific reporting requirements.

New Jersey

The Camden Coalition of Healthcare Providers has announced plans to establish a national center to improve care for high-need patients who experience poor outcomes despite extreme patterns of hospitalizations or emergency care. The Coalition, made up of health care providers, community partners and advocates, was founded by Dr. Jeffrey Brenner, whose work in Camden was featured in the 2011 New Yorker article The Hot Spotters.

New York

Enrollment in the Fully Integrated Duals Advantage care coordination program for people with developmental disabilities (FIDA-IDD) will begin in March with services commencing as early as April 1. Voluntary enrollment is available to dual eligibles over the age of 21 who receive long-term care and developmental disability services. The program is limited to individuals living in New York City, Long Island, Westchester or Rockland Counties. Partners Health Plan is the only plan selected by CMS to offer the FIDA-IDD program.

In other news, efforts by New York Governor Andrew Cuomo to increase wages for some low-wage workers are exacerbating a labor shortage among some home care providers. While the governor supports a statewide 15 dollar per hour minimum wage that would need to be enacted through legislation, he has already raised wages for various types of low-wage workers where he can do so through executive action. This has made jobs providing personal care and other services for disabled people – physically demanding jobs that have been notoriously low paying – ever more difficult to fill. Providers claim they need higher Medicaid reimbursement rates from the state to pay their employees higher wages.

OREGON

Health Share of Oregon, one of Oregon’s coordinated care organizations serving the Portland metropolitan area, recently proposed a plan to give Medicaid money to counties to run regional funding pools to better integrate behavioral health. The plan will be implemented by this summer.

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