State Withdraws Proposal to CMS
A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. To help solve the problem, CMS is going to test tow models to help states better align the financing for these two programs and to integrate primary, acute, behavioral health, and long term services to help Medicare-Medicaid enrollees.
To participate in Financial Alignment Demonstrations, states had to submit a proposal outlining their approach. On April 10th, Thomas Betlach, Director of Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency sent a letter to Melanie Bella, Director for the Medicare-Medicaid Coordination Office at CMS to withdraw Arizona’s proposal to pursue the CMS demonstration for members in Medicaid and Medicare.
Betlach gives several reasons why Arizona is withdrawing their proposal:
- Arizona is in the midst of two significant procurements for managed care plans with October 1, 2013 start dates involving complex transitions for members and services
- Additional procurements are scheduled during the three year demonstration period
- Significant political and operational challenges are involved with restoring coverage for childless adults and developing the infrastructure required for the ACA
- All current health plans help dual eligible Special Needs Persons or D-SNPs
- 43,000 members are currently aligned with contracted health plans
- General mental health/substance abuse services are currently not integrated for some members
In addition, some of the other risks for Arizona include the start date for implementation, the path forward after the three year demonstration, and the issues surrounding capitation rates and supplemental benefits.
The state of Arizona has therefore decided to pursue alignment through the use of the state’s managed care model. The State is looking to build off the D-SNP platform and move forward. In addition, the state is going to pursue partnerships with other states and the National Association of Medicaid Directors to leverage D-SNPs and build upon the success the state has had so far.
Dr. John H. Noseworthy, President and CEO of the Mayo Clinic in Rochester Minnesota remarked at the National Press Club, “Putting knowledge into practice quickly will create value that will benefit patients and produce high quality care at lower cost”. He realizes the Mayo Clinic and others need to obtain knowledge on what works and best practice protocols. (more…)
The threat of the emergence of infectious disease epidemics continues to concern policymakers and public health services. Better data is needed in terms of knowledge and tools to improve our knowledge of the emergence, surveillance, and detection of events alone along with knowledge on how to prevent these events. In order to complete these efforts, scientists need to be able to collect, analyze, and interpret the relevant data by developing models to guide the collection of further data. (more…)
The National Committee for Quality Assurance (NCQA) along with the Robert Wood Johnson Foundation (RWJF) is developing a new approach to measuring quality. The goal is to provide a more sensitive gauge of risk factors that will make it possible to create clinically meaningful incentives for providers to improve disease prevention.
Under a grant from RWJF, NCQA will evaluate a new measurement tool that focuses on improving the health outcomes of patients with heart disease and diabetes. The “Global Cardiovascular Risk” (GCVR) score, co-developed by NCQA and Archimedes, Inc., is considered the next generation quality improvement tool to measure how well providers can reduce the risk of future adverse outcomes such as heart attacks, strokes, and diabetic complications in the populations they serve. (more…)
The Leona M. and Harry B. Helmsley Charitable Trust awarded more than $6.5 million in grants to seven recipients seeking to develop new technologies to help people living with Type 1 Diabetes (T1D). The grants were made through the Trust’s T1D program as part of their Emerging Technology Initiative that funds earlier stage projects focused on drugs, devices, or therapies, and then moves them down the path towards commercialization. (more…)
Minnesota is in the process of establishing a state-based Exchange and as a result, the state is planning a statewide public education and awareness campaign aimed at reaching uninsured individuals and populations that will be the potential users of the Exchange. The Exchange is required to be fully operational beginning October 1, 2012 with the launching of the public education and awareness campaign to be launched in June 2013.
In February, the state issued an RFP which closed March 18th seeking proposals from qualified firms or contractors capable of providing a wide range of creative development, production, media buying, and marketing analysis services to design and produce a marketing campaign. (more…)
The Health Affairs April Issue examines high income countries struggling to achieve the so-called “Triple Aim” to achieve better health and better healthcare at lower cost. The April issue was supported by the Commonwealth Fund, Britain’s Nuffield Trust, and the Institute of Global Health Innovation at the Imperial College of London.
Several of the articles describe the lessons learned from other countries and how these successes can help the healthcare system. For example, faced with rising prescription drug costs, Australia instituted a strategy to cover new prescription drugs that save money without compromising quality. The article “Australia’s “Fourth Hurdle” Drug Review Comparing Costs and Benefits Holds Lessons for the U.S.” authored by Ruth Lopert and Adam Elshaug, describes how the country’s four step review links prescription drug prices with their quality and effectiveness. (more…)