Jennifer Spiller’s Post

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

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)

Health Affairs provides the authors (Centers for Medicare & Medicaid Services leaders) an opportunity to summarize their portfolio approach to achieving the stated goal - having 100% of Medicare beneficiaries in an accountable provider relationship by 2030. This is a helpful for those of you looking at the #valuebasedcare national landscape over the next three to five years, especially if you are supporting or selling into providers and provider organizations.

An openness to innovation at the Centers for Medicare & Medicaid Services may very well be bearing fruit. The implementation of value-based payment models for #primarycare providers appears to be improving the quality of these #health services and reducing unexpected, often costly, #healthcare expenditures incurred for #emergencycare.

Addressing Social Determinants of Health (SDOH) is pivotal in providing effective and equitable healthcare. The Centers for Medicate and Medicaid Services have rolled out a new model, the Making Care Primary (MCP) Model, which does just that. This model emphasizes integrated and coordinated primary care to improve health outcomes and addresses SDOH by leveraging community connections to meet health-related social needs, promoting whole-person care. We’re excited to see efforts on all fronts- from government to health providers, to community organizations- to address SDOH and foster health equity! https://lnkd.in/e3mfxX_x #Medicaid #SDOH #Hygieia #HealthEquity #MakingCarePrimary #PrimaryCare  

As a person who LOVES health care policy, I am incredibly excited to join my Premier Inc. colleagues Michael J. Alkire and Melissa Medeiros in authoring a blog ("Can ACOs Flex While Supporting Specialists?") that was published this morning by Health Affairs. In the blog, we dive into the Medicare Shared Savings Program ACO PC Flex model, recently released by the Centers for Medicare & Medicaid Services, and outline several concerns related to the structure of the model and congruency with CMS' goals of engaging specialists in ACOs, as well as other overarching issues. Check it out! #ACOs #PCFlex #Capitation #lowrevenue #highrevenue #MSSP #MedicareSharedSavingsProgram

Last month, the #MLTSS Association had the pleasure of presenting at the Medicaid Health Plans of America (MHPA) Conference, where we spoke about the need for improved #consumernavigation for the dually eligible population. As of 2021, there are over 12.8 million dually eligible beneficiaries nationwide, which account for a disproportionate share of spending across both the Medicare and Medicaid programs.  Several issues contribute to the complex nature of navigating integrated care in this dual-eligible market, including: -Lack of centralized resources  -Enrollment assisters at capacity  -Medicare plan finder challenges not equipped to share information across both programs  -Complicated state & federal marketing impeding abilities to educate consumers  At the MLTSS Association, we asked our plans how we can improve consumer navigation for dual-eligibles both pre and post-enrollment. Check out our presentation here. https://lnkd.in/eCdWuKTP

"#MedicareAdvantage is the best chance #taxpayers and #consumers have had in decades to transform #medicine from sick care to health care. The idea is to offer incentives for private businesses to improve overall #health — and reduce overall costs — by focusing on #wellness and #prevention over traditional fee-for-service medicine for #doctors and heads in beds for #hospitals." However, "The four main groups supporting Medicare Advantage — #payers, #providers, #patients and #policymakers — are like a table with four legs. We need each one to hold up their end of the deal." #HealthcareReform #HealthcareTransformation #HealthEquity #SDoH #PublicPrivatePartnership #PublicPrivatePartnerships #ObamaCare #healthcarequality #healthcarecosts #primarycare #populationhealth #capitation

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.

Around 10,000 Americans turn 65 years old every day, gaining access to Medicare benefits. The number of Medicare beneficiaries is expected to continue growing in the next five years, and health systems are making changes to keep up. #Healthcare #Medicare #HealthIT