Rock Health’s Post

The recent report from Center for Health Care Strategies and California Health Care Foundation, "Addressing Travel Costs for Providers of Field-Based Services in Medi-Cal," highlights a significant challenge faced by providers of field-based services, such as community health workers, doulas, and behavioral health providers. These professionals often deliver essential care in homes, schools, and community settings, bridging gaps for Medi-Cal members, especially in rural and hard-to-reach areas. However, Medicaid does not directly reimburse travel costs, creating a significant barrier to sustained service delivery. Key Findings and Implications: - Access to Care is at Risk: Without reimbursement for travel, providers may reduce or discontinue services in remote areas, or increasingly rely on telehealth, which may not always meet members' needs. This is particularly concerning for rural and frontier regions where in-person services are vital. - Need for Tailored Solutions: A "one-size-fits-all" approach is not viable. The report emphasizes the need for solutions that address the unique travel time and expenses of different services and provider types. This could involve differentiated rates, incentives, or additional support to reflect the realities of delivering field-based care. - Policy Recommendations: States and managed care plans can make a difference by: * Surveying providers to fully understand their travel costs and incorporating these into reimbursement rates. * Developing service rates that reflect travel and other indirect costs, ensuring that service limits do not inadvertently increase financial burdens on providers. * Offering incentives for field-based services, adjusting rates based on geographic challenges, and supporting providers who predominantly deliver care in the field. Impact on Foster Family Agencies and Behavioral Health Providers: This issue is particularly relevant to foster family agencies and behavioral health providers who often work in challenging settings to meet the needs of vulnerable populations. Ensuring that these providers are adequately compensated for their travel expenses is critical to maintaining access to high-quality, person-centered care. Call to Action: We must advocate for policy changes recognizing the true costs of delivering field-based services. Supporting providers in this way will enhance access, reduce inequities, and help ensure that all Californians, regardless of location, can receive the care they need. Read the full report to understand how these recommendations could reshape access to care for Medi-Cal members and drive change in the healthcare landscape: https://lnkd.in/gU9_X7wZ

Ten Commandments of Health Care Designers and Leaders and CEOs Thou shalt not focus on any area other than health care delivery actions and team members with top focus on their support and the facilitation of care and caring Thou shalt not focus on assumptions and concepts that distract from the ability to deliver the care (overutilization focus with cost cutting priorities, micromanagement increase without proof of concept) Thou shalt not appear to be about health care or health equity when your actions are shaping compromise in the delivery of health care or health equity Remember the practice and hospital environments and keep them wholesome and free of toxicity Honor the patient and the caregiver and facilitate their support Thou shalt not kill hundreds of hospitals and countless practices, jobs, delivery team members, and locally focused health and community leaders where most Americans are most behind in all of these areas Thou shalt not collude with other people who do not share the health care delivery focus (private equity, others) Thou shalt not steal from state and federal treasuries and drain the finances of the American people and deplete government of the ability to invest in children, education, jobs, security, public health, economic development, and other essential government functions. A Health Care Designer or Leader Must Must Not 1. Compromise populations already most vulnerable which are increasing most rapidly from 40% to become a majority in just a few decades 2. Compromise providers who serve most Americans that are most vulnerable 3. Compromise delivery team members by worsening finances or by added duties 4. Favor highly subspecialized services over basic health access services. In general all specialties and subspecialties have complexity. Their teams need the same team member numbers and ratios and the same high levels of training and experience and continuity to be able to share the complexity. 5. Implement policies or design changes without beneficent intent (cost cutting is not generally beneficent. Quality improvement is difficult and often not possible via health care design since drivers of outcomes are outside of health care and more important in shaping outcomes Favor those in their charge who do not deliver the care more than those in their charge who deliver the care Add more lines of revenue and more highest paid services and preserve highest payments for those doing well at the cost of declines in health care for most Americans and at the cost of destruction of basic health access There is little over the past 40 years from DRG and RBRVS to ACA, ACO/Shared Savings, Star Ratings, Readmissions, Medicare Advantage, and Value based design that has not worsened health care delivery across the basics, across most of the American people, and across the wide range of delivery team members.

🏥 This is a powerful article that brings up a pretty valid point for anyone in healthcare... #SDOH initiatives remain popular because they enable states and organizations to access substantial federal healthcare funds that would otherwise be less available for social services. However, to truly make an impact, the quality of research supporting initiatives to tackle social determinants of health (SDOH) needs significant improvement. Many studies on non-medical drivers in patient outcomes lack proper experimental controls, randomized controlled trials, and the ability to track impact over time. While SDOH interventions reflect a desire to tap into abundant federal healthcare funds, particularly Medicaid, expanding healthcare programs to cover non-medical services will not significantly reduce healthcare costs or effectively address social issues. Policymakers should resist expanding Medicaid for non-core benefits and avoid placing the responsibility for SDOH on healthcare providers. Effective social policies should be developed and funded independently of the healthcare system to ensure resources are allocated where they are most needed. By doing so, we can address social issues more effectively without burdening healthcare providers with tasks outside their expertise. 🗣 I would love to hear your thoughts on this in the comments below. #patientcare #healthpolicy #healthcareinnovation #healthcarefunding #patientadvocacy #healthequity

𝗧𝗵𝗲 𝗖𝗲𝗻𝘁𝗲𝗿 𝗳𝗼𝗿 𝗛𝗲𝗮𝗹𝘁𝗵 𝗜𝗻𝗳𝗼𝗿𝗺𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗔𝗻𝗮𝗹𝘆𝘀𝗶𝘀 (CHIA) today released its Annual Report on the Performance of the Massachusetts Health Care System. The Annual Report examines trends in costs, utilization, coverage, and quality indicators through 2022, a period following two years of volatile health care utilization and spending due to the COVID-19 pandemic. New this year, the report includes a chapter on health care affordability that presents a consumer-centric picture of rising health care costs and its downstream implications, as well as a section and interactive dashboard that provides comparative insights into how medical spending varies by community demographics. In 2022, Massachusetts total health care expenditures (THCE) accounted for $71.7 billion, a 5.8% increase from 2021, exceeding the 3.1% health care cost growth benchmark. Other key findings: • Between 2020 and 2022, member cost-sharing, premiums, and claims covered by payers and employers increased faster than regional inflation and wages and salaries. • Pharmacy and non-claims payments were the largest contributors to the THCE increase in 2022. The nonclaims growth was primarily driven by $621.5 million in new COVID-related supplemental payments that MassHealth made to support the financial stability of eligible providers pursuant to state and federal legislation. • Commercial enrollment in high deductible health plans (HDHPs) grew to 42.4% of members in 2022, continuing a growth trend that has more than doubled over the last 10 years (in 2014, 19.0% of members were enrolled in HDHPs). • In 2021, over four in 10 Massachusetts residents reported experiencing health care affordability issues in the past 12 months (41.0%), including more than half of Hispanic residents (54.9%) and Black residents (50.8%). • The statewide acute hospital median total margin decreased by 9.2 percentage points, from 5.0% in HFY 2021 to -4.2% in HFY 2022; this was followed by an increase to a statewide median total margin of 1.6% in HFY 2023, as of data reported through June 30, 2023. • Acute hospital average length of stay has steadily increased year-over-year, while inpatient, emergency department, and outpatient observation visits have declined and remain lower than pre-pandemic volumes. • In 2022, behavioral health spending represented 7.4% of private commercial health expenditures, 16.2% for MassHealth, and 3.1% for Medicare Advantage, with a majority of behavioral health spending for mental health services. The Annual Report also examines hospital utilization, payer and provider financial and quality performance, and spending trends related to behavioral health, telehealth- and COVID-19-related services. Supporting materials include a databook, datasets, and technical appendices. Read the full report and download the supporting materials at https://lnkd.in/etYy4ZKa

The latest issue of Health Affairs explores the challenges related to addressing housing needs through Medicaid. Duke Margolis Center for Health Policy researchers and implementation partners find the Healthy Opportunities Pilot offers actionable insights for other states seeking to address this critical health-related need. Read more about their findings at https://ow.ly/Qwfz50QyrIP

Why would Community Health Centers support value based care payments? Why would anyone with the most complex patients that has the worst financial design and the worst payers including constantly being held hostage directly by Congress? Why would anyone with high proportions of Medicaid trust payers to pay more after 40 years of cost cutting designs across CMS and states. Performance based penalties are now more understood as punishing providers who serve the most complex patients that have the lowest levels of outcomes and drivers of outcomes inherently plus limitations in support, health literacies, digital literacies... Perhaps like primary care leaders supporting value based, the CHCs are so desperate for any financial improvement potential that they are willing to risk it. People in severe pain will grab for some relief even with a 50% chance of bad side effects or death. Why do we NOT VALUE basic health access in this nation? That is my continual question. These are quotes from the Commonwealth article "Despite their positive outlook on VBP in the long run, the health center leaders we spoke with still feared what it would mean for them on the ground, particularly in the short term with regard to payment levels and practice management. Their main concern was that without carefully designed models and payments, VBP could exacerbate FQHCs’ existing financial woes. “In New York, our reimbursement rates for funds have been flat for about 10 years. So how will [VBP] impact us? What will change?” said a chief medical officer in New York. Health centers serve high-risk populations and are concerned about the prospect of taking on financial risk and being exposed to penalties. A chief medical officer from Tennessee said: “We worry that the [VBP models] will penalize people who take care of the sickest patients and the ones with the most social barriers to care.” This concern is not unique to health centers, but it is particularly worrying given their already limited financial resources and higher share of uninsured patients. Successfully implementing VBP requires data systems for reporting and monitoring population health, changes to care delivery, and hiring and training staff. Given their already limited margins, FQHCs said that they would need initial financial support and technical assistance. A chief executive officer from a Texas FQHC said: “One barrier is the lack of funds to help position us to have the type of infrastructure, including the technological infrastructure, to be able to track and understand what needs to be reviewed and submitted. It also takes staff members understanding what value-based care means on a daily basis, operationally. There’s a lot of training needs.”" https://lnkd.in/ewd4HhYV?

✍🏻 Findhelp's Connections Blog: Health Equity Measures ✍🏻 Social care and health equity quality measures exist to ensure healthcare organizations are providing high-quality services that relate to one or more goals including effective, safe, efficient, patient-centered, equitable, and timely care. The Joint Commission, NCQA (National Committee for Quality Assurance), and Centers for Medicare & Medicaid Services (CMS) have all introduced new or updated requirements to advance health equity. Healthcare and payer organizations are required to report on their efforts to reduce health disparities, screen patients for social drivers of health (SDoH) needs, and ensure positive outcomes. Read our latest blog post to learn how we're supporting organizations like Elevance Health, Novant Health, NC MedAssist, Camden Coalition, and Ascension into 2024 across these various policies, accreditations, certifications, and requirements. ✅ Read our blog ➡ https://hubs.li/Q02dwctV0 #findhelp #quality #HealthEquity #QualityMeasures #SocialCare

In the evolving world of healthcare, a trend is emerging: the integration of community-based organizations (CBOs) with healthcare organizations (HCOs) to address social determinants of health (SDOH). This collaboration is reshaping our approach to healthcare, particularly for the underserved. Medicaid and CHIP, supporting 76 million low-income Americans, are leading this transformation. States are employing innovative policies like Section 1115 demonstrations, Managed Care Contracts, and In Lieu of Services (ILOS) to effectively meet the health-related social needs (HRSN). This goes beyond traditional healthcare; it's about overall well-being. The role of CBOs in this shift is critical. They are key in providing equitable access to vital services, ranging from housing to nutrition. The partnership between HCOs and CBOs is creating a more holistic health approach, integrating medical, behavioral, and social care. The current challenge is ensuring these partnerships are effective, adequately funded, and capable of making a real difference in health outcomes and disparities. How can we further strengthen these vital collaborations for a healthier future? Read the full article here. https://lnkd.in/gknHbRas

As implementation yields new insights, CMMI continues to refine approaches to advancing health equity with the goal of incorporating promising features and practices into the Medicare and Medicaid programs. A recent article from Health Affairs provides an update on progress since last year and lays out new work in 2024 in three areas: safety-net provider participation in models to improve care for more beneficiaries, data collection that supports whole-person care, and payment innovations to narrow disparities. To read the full article, visit https://bit.ly/4cpQQWu

𝗧𝗵𝗲 𝗖𝗲𝗻𝘁𝗲𝗿 𝗳𝗼𝗿 𝗛𝗲𝗮𝗹𝘁𝗵 𝗜𝗻𝗳𝗼𝗿𝗺𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗔𝗻𝗮𝗹𝘆𝘀𝗶𝘀 (CHIA) today released its Annual Report on the Performance of the Massachusetts Health Care System. The Annual Report examines trends in costs, utilization, coverage, and quality indicators through 2022, a period following two years of volatile health care utilization and spending due to the COVID-19 pandemic. New this year, the report includes a chapter on health care affordability that presents a consumer-centric picture of rising health care costs and its downstream implications, as well as a section and interactive dashboard that provides comparative insights into how medical spending varies by community demographics. In 2022, Massachusetts total health care expenditures (THCE) accounted for $71.7 billion, a 5.8% increase from 2021, exceeding the 3.1% health care cost growth benchmark. Other key findings: • Between 2020 and 2022, member cost-sharing, premiums, and claims covered by payers and employers increased faster than regional inflation and wages and salaries. • Pharmacy and non-claims payments were the largest contributors to the THCE increase in 2022. The nonclaims growth was primarily driven by $621.5 million in new COVID-related supplemental payments that MassHealth made to support the financial stability of eligible providers pursuant to state and federal legislation. • Commercial enrollment in high deductible health plans (HDHPs) grew to 42.4% of members in 2022, continuing a growth trend that has more than doubled over the last 10 years (in 2014, 19.0% of members were enrolled in HDHPs). • In 2021, over four in 10 Massachusetts residents reported experiencing health care affordability issues in the past 12 months (41.0%), including more than half of Hispanic residents (54.9%) and Black residents (50.8%). • The statewide acute hospital median total margin decreased by 9.2 percentage points, from 5.0% in HFY 2021 to -4.2% in HFY 2022; this was followed by an increase to a statewide median total margin of 1.6% in HFY 2023, as of data reported through June 30, 2023. • Acute hospital average length of stay has steadily increased year-over-year, while inpatient, emergency department, and outpatient observation visits have declined and remain lower than pre-pandemic volumes. • In 2022, behavioral health spending represented 7.4% of private commercial health expenditures, 16.2% for MassHealth, and 3.1% for Medicare Advantage, with a majority of behavioral health spending for mental health services. The Annual Report also examines hospital utilization, payer and provider financial and quality performance, and spending trends related to behavioral health, telehealth- and COVID-19-related services. Supporting materials include a databook, datasets, and technical appendices. Read the full report and download the supporting materials at https://lnkd.in/dQS2kwJ