Ellen Schultz’s Post

 A great view into the past 15 years of quality measurement in Medicaid including progress, key obstacles, and recommended solutions from the perspective of Medicaid medical directors. These individuals (mostly physicians) have experience in providing direct patient care as well as expertise in oversight over Medicaid program services, payment, and quality measurement, thus providing unique insights into multiple levels of the health care delivery system. The three authors of this article are current or past Medicaid medical directors. https://lnkd.in/ebwiPhKQ

Check out my first Health Affairs publication! https://lnkd.in/efcHQvEQ   The article highlights linkages that connect existing policies and programs to coordinate Medicare and Medicaid benefits for those most vulnerable among us, the frail elderly and people living with disabilities, who are overwhelmingly dually eligible for both government programs. This work is being done by an outstanding heterogenous group of long-term care focused organizations consisting of a health plan (VNS Health), a group of home care providers (Coalition for Excellence in VBC at Home), and a clinical care technology company specializing in older adults (Vesta Healthcare).    I hope that this publication can provide an example of why a state-driven plan is needed to grow enrollment in New York’s fully integrated arrangements (e.g., PACE and MAP) for the majority of dually eligible beneficiaries with long-term care needs, and how innovative and incremental approaches by New York's healthcare delivery partners can be embraced to maximize the benefits of Medicare-Medicaid integration along the way. 

What role can randomized evaluations play in evaluating the impact of Medicaid? A new op-ed in Health Affairs from J-PAL North America Co-Scientific Director Amy Finkelstein and former Connecticut Medicaid Director Gui Woolston shows how Medicaid offices can rigorously evaluate their programs using randomized evaluations to improve program effectiveness and impact. The authors propose two approaches and five actionable steps that Medicaid offices can take to begin the evaluation process. https://lnkd.in/dGizuhqX Want to evaluate your program? J-PAL North America is ready to support any Medicaid offices interested in conducting randomized evaluations of their programs.

In their new Forefront article, Jeffrey Schiff, Clara Filice, and Christopher Chen from AcademyHealth, MassHealth, and Washington State Health Care Authority discuss how the time is ripe to reexamine what the past 15 years of investment in Medicaid quality measurements has yielded and to identify opportunities to better measure what matters to Medicaid members. "The innovative efforts to develop the National Quality Strategy—coupled with the implementation of mandatory reporting for the Medicaid Child Core Set, the behavioral health measures of the Adult Core Set, and the Health Home Core Set—have reignited longstanding interest in measure selection, standardization, and alignment across CMS programs.or this ambitious vision for quality to come to fruition for all citizens served by CMS, particular attention to measurement for the Medicaid (note 1) and CHIP programs must be front and center. These programs serve one in five Americans and 40 percent of all children. The time is ripe to reexamine what the past 15 years of investment in Medicaid quality measurements has yielded and to identify opportunities to better measure what matters to Medicaid members." Read the full article here: https://bit.ly/3TaAMj3

Ever heard the old saying 'what gets measured gets managed' ? It certainly holds true for many areas of #healthpolicy. But, have national #Medicaid and #CHIP #quality #measures really driven quality improvements and measurably improved patient outcomes? A new Health Affairs forefront study looking at the Centers for Medicare & Medicaid Services track record over the past 15 years of quality measurement purports that these quality measurements have fallen way short of their promise - for several reasons including structural and logistical challenges, data limitations, onerous reporting burdens, a limited ability to measure the quality attributes that matter most to the #Medicaid and #CHIP population, and the list goes on.. Regardless of whether you agree with this somewhat contentious conclusion, the article's comprehensive overview of the history of quality measures is in itself very much worth a read and the debate about whether we are measuring the right things is certainly very much worthwhile. See the study here:

😓 Many health plans are still navigating challenges attached to Medicaid enrollment losses. So ICYMI: Here is a breakdown of 4 considerations to help combat these changes: 1️⃣ Collaboration is Key: Partner with other health plans, community organizations, and technology providers to leverage a broad spectrum of expertise and resources. 2️⃣ Clear Communication: Maintain consistent communication strategies to help members transition smoothly and understand their coverage options. 3️⃣ Optimize Resources: Use AI and automation to handle repetitive tasks, freeing up staff to focus on critical member support. 4️⃣ Simplify Enrollment: Make it easy for members to move to alternative coverage options. Provide a seamless, single-sign-on shopping experience for medical, dental, vision, and supplemental coverage. By focusing on these strategies, you can effectively pivot to the ACA Marketplace and support members through the transition. #HealthPlans #Medicaid #ACA

HFS TO EXTEND CURRENT MCO CONTRACTS IN HEALTHCHOICE ILLINOIS FOR AN ADDITIONAL YEAR | Helpful extension... The Department of Healthcare and Family Services will extend its current contracts with Medicaid managed care organizations in the HealthChoice Illinois program for an additional year as new leadership settles in, Director Elizabeth Whitehorn said Friday. [Health News Illinois] Whitehorn, who began the role in January, told members of the Medicaid Advisory Committee that the decision to postpone the procurement process by a year would give them the “appropriate time to ensure the process is designed to drive healthcare transformation.” “We really value input from our stakeholders and our customers and believe that incorporating the feedback at the front end will lead to a better final procurement,” Whitehorn said. The contracts are currently in the sixth year of an eight-year deal, she said. HealthChoice Illinois covers roughly 80 percent of all the state's Medicaid enrollees. The focus for future contracts will include prioritizing behavioral health, maternal and child health, health equity and “accountability," Whitehorn said. That will include higher standards for performance metrics, financial withholds for both pay-for-performance and pay-for-reporting elements, and standardizing quarterly reviews of individual plan performances. “We'll continue to grow the team and have some fresh perspective on how we work with our MCOs,” Whitehorn said. “I really hope this additional time will ensure the success of procurement for the agency, for the state and — most importantly — for our customers.” The department is working on requests for proposals for a new fully integrated dual-eligible special needs plan, she said. That comes after the Centers for Medicare and Medicaid Services notified the state that it will not extend the Medicare-Medicaid Alignment Initiative demonstration program past 2025. The program covers about 90,000 consumers who are dually eligible for Medicaid and Medicare. The requests for proposals are expected to be released later this spring. For more news and updates , visit IOMC's Blog here> https://lnkd.in/gfb8mw6M #achieve #blackleadership #latinoleaders #families #medicaid #medicare #behavioralhealth #maternalhealth #socialchange #healthequity #publichealth #populationhealth #communityhealth

How can #Medicaid policymakers advance the adoption of value-based arrangements by Federally Qualified Health Centers? 1.     Through the Return of Shared Savings to #FQHCS. – Participating FQHC networks should be eligible to share in a substantial portion (50% or more) of the savings realized when the actual total costs incurred for their attributed population are below the benchmark or goal set for average Total Cost Of Care (TCOC). 2.     Adjust the Payment Model for the FQHC Patient Population. – The benchmark costs used to set rates should be based on the average #TCOC in the market, or the average amount the Managed Care Organization gets paid per enrollee, rather than using the FQHC networks’ own historical low reimbursement as a starting point. Learn more in this report authored by our Kim Prendergast, Aditya Mahalingam-Dhingra, and Vikki Wachino for the Milbank Memorial Fund - https://lnkd.in/eCGMECd2 #Valuebasedcare ##FQHC #ACO #TCOC #Medicare #ProspectivePaymentSystem #ManagedCare #Managedcareorganizations #VBP #Healthcarequality #CMS #healthequity #Communityhealthcenters #Communityhealth Massachusetts League of Community Health Centers National Association of Community Health Centers (NACHC)

For primary care advocates, there’s a lot to like in the direction laid out in Centers for Medicare & Medicaid Services leaders’ latest Health Affairs blog: Expanding Permanent Pathways for Accountable Care. We know primary care-centric ACOs in the Medicare Shared Savings Program are outpacing others. Today CMS signaled interest not just in continued model tests at the CMS Innovation Center but in permanent improvements aimed at strengthening primary care. This direction has promise… and it’s good to see the agency double down on their commitment to primary care. To get the details right on this new direction, we urge the agency to continue engaging deeply with the #PrimaryCare community. https://bit.ly/4dEuKj7

Tune into this AJMC - The American Journal of Managed Care interview as Carrie Kozlowski, OT, MBA, COO, and co-founder of Upfront Healthcare, discusses the impact of increasing Medicaid disenrollment on the US health system. Watch here!