« The Dual Agenda: June 24, 2015 Issue

Noteworthy News

CMS Considers ACO Model for Dual Eligibles

Patrick Conway, M.D., CMS Deputy Administrator for Innovation & Quality and Chief Medical Officer recently acknowledged that CMS is considering developing an accountable care organization-type model for beneficiaries who qualify for both Medicare and Medicaid. Conway said that CMS has begun discussions with some states and providers about the concept. These comments were part of Conway’s keynote address to the Sixth National ACO Summit.

Medicaid Balancing Incentive Program Increases Access to Home and Community Based Services

Kaiser has issued the results of a survey administered to the eighteen states currently participating in the Medicaid Balancing Incentive Program (BIP) to increase access to home and community-based services (HCBS) as an alternative to institutional care. Established by the Affordable Care Act, BIP has authorized $3 billion in enhanced federal funding from October 2011 through September 2015. As a condition of participation in the program, states must implement certain structural changes and spend a specific percentage of their total Medicaid long-term services and supports (LTSS) dollars on HCBS. The survey found that the availability of enhanced funding is increasing access to HCBS, and BIP funds are creating opportunities to build upon existing Medicaid LTSS rebalancing efforts already underway. 

New Report on Barriers to Integrating Behavioral and Physical Health

The Blue Cross Blue Shield Foundation of Massachusetts (BCBSMA) issued a report on policy and regulatory barriers to integrating behavioral and physical health in Massachusetts. Such integration is one of the key goals of the dual-eligible demonstrations. The report identifies three kinds of obstacles to integration: licensing barriers, privacy barriers and reimbursement barriers. The licensing and privacy sections of the report include several options for overcoming the identified challenges, while the reimbursement section identifies payers, including state Medicaid programs, that are addressing those issues.

Independence at Home Demonstration Reports Encouraging Results

CMS reports positive results from the first performance year of the Independence at Home Demonstration, including both higher quality care and lower costs. The Demonstration provides chronically ill Medicare beneficiaries with primary care services in the home setting. In the first performance year, 17 participating practices served over 8,400 Medicare beneficiaries. The analysis found that Independence at Home participants saved over $25 million in the first year – an average of $3,070 per participating beneficiary. In addition, all 17 participating practices improved quality in at least three of the six quality measures, and four practices met the improvement metrics for all six quality measures. For example, the study found that participating beneficiaries, on average, have fewer 30-day hospital readmissions and follow-up contact from their provider within 48 hours of a hospital visit.

Innovative Care Model for those with Dementia and Depression

A study by the Regenstrief Institute at the Indiana University Center for Aging Research and Eskenazi Health reports that Aging Brain Care Medical Homes, a population health management program implemented in the homes of older adults, achieves significant health improvement for individuals with depression and also substantial stress reduction in family caregivers of dementia patients. The model depends on care coordinators who go to patients’ homes, evaluate the home environment and the needs of the patient and caregivers, and communicate with the medical team. The researchers found at least a 50 percent reduction in symptoms in two-thirds of patients with moderately severe depressive symptoms and a 50 percent reduction in stress symptoms in half of caregivers of patients with dementia.

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