Claire Boozer Cruse, MPH

#CMS recently made a first set of announcements about states set to join the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. The goals of the model are to improve overall population health of a state or sub-state region, reduce health disparities, and curb health care cost growth, using hospital global budgets as a key lever. CMS is setting the default for how Medicare reimbursement will work under a global budget, but states have choices to make with how Medicaid will implement a similar strategy. Manatt's Lora Kim, Edith Coakley Stowe and Anne Karl provide an overview of the model and top considerations related to Medicaid here: https://lnkd.in/emf8GzxE

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📢 COMING TOMORROW: Our June 2024 report includes recommendations to Congress on improving the transparency of financing the non-federal share of #Medicaid and #CHIP and recommendations to states that address integrated care for people who are dually eligible for Medicaid and #Medicare, and more!

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There's still time to register for next week's webinar on PHM. We'll discuss a model that makes a very compelling business case! #PHM #PopulationHealthManagement #Wellness #EmployeeHealth #EmployeeWellness #HealthandWellbeing

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Primary care providers need more support from Congress to participate in value-based care, according to America's Physician Groups’ Susan Dentzer. Enacting long-term physician payment reform that prioritizes quality and makes reimbursement predictable is key to bringing more primary care providers into value-based arrangements. More from Healthcare Innovation ⬇ #ValueBasedCare #Medicare #PrimaryCare 

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While the Medicaid unwind started last year, we’re still seeing the effects in 2024. Millions of Americans have lost Medicaid coverage and states are deciding how to proceed. Some states are adopting coverage expansions like the Affordable Care Act Medicaid expansion, which will provide coverage for those who don’t qualify for Medicaid or premium subsidies in the ACA Marketplace. Other states are expanding coverage for specific groups, such as children. No matter how states handle the Medicaid unwind, many people will be left without access to affordable healthcare. There will still be coverage gaps, and even among those who do have insurance, some won’t be able to afford the deductibles and copays. That’s what safety net clinics are for. We provide care that’s local, inexpensive, and accessible regardless of insurance coverage. We know that increasing insurance coverage isn’t enough. Patients need care that’s affordable with or without insurance. #safetynet #healthcare #healthinsurance #medicaid #medicaidunwind

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Core to Cityblock’s value-based care model is the integration of physical and behavioral health services. In this newly published peer-reviewed article in Population Health Management, David Dayan-Rosenman, MD, MS and Steven Spencer, MD, MPH, MBA describe the framework and implementation of a structured program that has effectively upskilled primary care providers in medication treatments for substance use disorders, supporting our Medicaid and dual-eligible members with interdisciplinary teams trained in harm reduction. Read more: https://lnkd.in/g4S6SUad

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The Marketplace Affordability Project Report (MAP-Report) is out! CHLPI Director of Health Care Access Elizabeth Kaplan participated in the Working Group that helped create the report! Here are some key findings: 1. #ACA reforms expanded coverage, especially for marginalized communities. Now we can build on that success by making sure enrollees can afford premiums and needed care. 2. Expensive cost-sharing can make it hard to afford services that prevent and manage chronic conditions. This disproportionately impacts marginalized communities and should be a priority for policymakers looking to build on the success of the ACA. 3. High deductibles can cause financial burdens for marketplace enrollees without large emergency savings, meaning that unanticipated medical expenses limit wealth building in marginalized communities. 4. Enhanced #PremiumTaxCredits have made more generous plans accessible to low-income enrollees, addressing barriers to care. Policymakers should make them permanent. Policymakers can build on the success of the ACA by supporting consumer assistance programs. Doing so is crucial for improving healthcare access and empowering individuals to make informed and cost-effective decisions. Thank you to everyone who worked to get this report out! Check out the Center on Budget and Policy Priorities blog on the report here: https://lnkd.in/eADkvzze #MAPReport Read the report here: https://lnkd.in/e-pgAzmd

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What is stewardship and how can it create an enabling environment for #FamilyPlanning and maternal, newborn, and child health products and services? Check out this Frontier Health Markets (FHM) Engage brief, which highlights stewardship through the lens of the market development Approach, and explains stewardships through functional terms, focusing on “what is done,” “what should be done,” and “who should do it.” Read the brief to understand how to foster sustainable impact for country-level #FP and #MNCH goals: https://ow.ly/R60w50SrXim

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Should inflation affect long-term spending goals? States that set annual health care cost growth targets for health care expenditure growth tie those targets to projections of economic indicators and historical averages. However, these targets don’t account for unforeseen circumstances like recent rates of inflation. A new blog from Matthew Reynolds and Alyssa Vangeli of Bailit Health discusses how states with cost growth targets have responded to inflation. While most states opted not to adjust the targets given concerns about sanctioning increased spending and maintaining predictability in the target-setting process, Rhode Island and Connecticut did adjust their targets. “While the inflation spike has since moderated, cost growth target states may have to contend yet again with unanticipated macroeconomic changes in future years,” the authors say. “The political and methodological considerations weighed by all of the cost growth target states, and the different decisions they have made, may prove instructive when states evaluate whether and how to account for inflation rate changes in the future.”

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A new Vizient, Inc report found Medicaid patients were less likely to receive the same treatment services for behavioral health as compared to commercially insured patients. The variation in access and inadequate treatment, could also lead to higher utilization of the emergency department. "The results of this study demonstrate differences in access to care by payer," said Erika Johnson,VP, Vizient Strategic Research. "Providing a fair and appropriate standard of care across all patient populations means expanding provider access for mental health services across all types of payers. Some hospitals are utilizing social workers, nurse practitioners and physician assistants to close the gap in care. By expanding access earlier on, patients are less likely to need to use the emergency room for care, thereby delivering better patient care," said Stephanie Snider, consulting director, Vizient Intelligence. The Vizient Research Institute conducts research focused on broad healthcare economic trends affecting the affordability and sustainability of our healthcare delivery system. https://viz.inc/4anWvuk View Shining a light on disparities in mental health services: ➡️ https://viz.inc/44H6RUS #MentalHealthAwarenessMonth

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Ignitist has discussed how the Medicaid Unwinding process has unveiled flaws in the way we deliver health insurance to low-income individuals and families. Unfortunately, this is only becoming more apparent as the unwinding process continues. Today, a Washington Post article discusses how 1 in 3 people disenrolled from Medicaid in the past year had no idea they were enrolled in the first place, believing themselves to be uninsured. In effect, these individuals were not taking advantage of coverage that would help them stay healthy throughout the pandemic. Additionally, a KFF article that came out today discusses the disproportionate effect of disenrollment on disabled people. Many disabled individuals who still qualify for Medicaid are finding themselves devoid of necessary care without appropriate notice, or in some cases, without notice at all. We hope that CMS and state Medicaid systems will address these issues moving forward. Communicating with beneficiaries is vital to the functioning of our healthcare system, and Medicaid-qualifying individuals are often the citizens who need the most support. Let's work together to keep our country healthy! Washington Post - Why Medicaid’s ‘undercount’ problem counts: https://lnkd.in/eXMD6P-T KFF Health News - Medicaid ‘Unwinding’ Decried as Biased Against Disabled People: https://lnkd.in/edxmwrrm #Medicaid #MedicaidUnwinding #Accessibility

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#ICYMI: #CMS made an internal executive decision to ignore #Congress legislative mandate to complete Medicaid Unwinding by the end of June 2024, extending Unwinding efforts another year. But this decision impacts State budgets. Buried in the extension is the requirement for States to accept client/applicant #selfattestation of #residency as fact. (Self-Attestation without #dataverification is the #1 contributor to fraud, waste, and abuse as determined in numerous US Government Accountability Office and #InspectorGeneral reports. Residency verifications are a critical tool to confirm that the correct State is administratively and financially responsible for public assistance benefit programs.) An independent peer-reviewed study from NYU and Harvard just released found 30% of individuals contacted during #Medicaid #Unwinding were UNAWARE they were even enrolled in the program and advised they had not signed up through the CMS Federal Marketplace/Hub. That's 6 MILLION people. The average annual State capitation rate is ~$14k per person. That's $84 BILLION in lost State capitation expenditures. And we extend this unacceptable loss of #taxpayer #resources with a waive of a pen? Where is the #accountability or #oversight? The National Association of State Budget Officers have reported a tightening State fiscal outlook for FY2025 due to the end of American Rescue Plan Act funds and the need to replenish State coffers/reserves (rainy day funds). The biggest budget item for States... Medicaid. https://lnkd.in/ecBwmQ-m #fraudwasteabuse Jodey C. Arrington Paul Johnson Ben Hobbs #trustbutverify #chevrondeference SCOTUSblog #ConsolidatedAppropriationsActof2023 #FamiliesFirstCoronavirusResponseAct

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Across the country, no two states are alike in how they define and regulate telehealth. To help policymakers, health advocates and other health care professionals understand the policies and trends throughout the nation, PHI's Center for Connected Health Policy compiles the latest telehealth policy updates and trends via their Telehealth Policy Finder tool. One recent update: In New York, Medicaid issued an update in January announcing that they would reimburse for eConsults effective April 1, 2024. Explore the full tool: https://lnkd.in/gshsBvKr #Telehealth #HealthPolicy #Medicaid

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News from First Report Managed Care Volume 21, Issue 2: The Centers for Medicare & Medicaid Services (CMS)'s AHEAD model aims to improve population health management by awarding funding to states and promoting primary care investment and enhanced equity measures, but implementation challenges and cultural shifts may hinder its success. “States have relationships with many of the stakeholders whose perspectives and support will be vital to the success of this model,” Maureen Hennessey, PhD, SVP, director of value transformation at Precision AQ, told First Report Managed Care. Access the full issue here: https://lnkd.in/eKAWrpWp #FirstReportManagedCare #FRMC #CMS #AHEADModel #PopulationHealth

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses 3 types of assets (financial, physical, and social) that unlock access to resources and shape population health. https://ja.ma/3yaXEYV

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RISE reviews the latest #SDoH headlines: • HHS invests $27.5M in women’s behavioral health • Report ranks most socially responsible hospitals • Report: Patient experience scores on the rise, disparities remain

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In our latest #economic lens our guest contributor Nicholas Hicks FRCP FRCGP FFPH shares some observations about  the nature of outcomes in health care and health systems and the attribution of outcomes to inputs and process.  He also puts forward six key questions about health outcomes that decision makers in healthcare may want to consider whenever they encounter health economic analyses. Read his article here: https://lnkd.in/g4UMyeTP      #healtheconomist #healthcareeconomicanalyses #healthcareoutcomes #healthsystem

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