This week, we reviewed the agreement-in-principle between the State of Washington Health Care Authority (HCA) and the Centers for Medicare & Medicaid Services (CMS) on a new section 1115 demonstration waiver, which will further the state’s Healthier Washington initiative across three major dimensions. The agreement will provide up to $1.5 billion in federal funding for delivery system reform incentives, expanded options for long-term services and supports, and supportive housing and employment. HCA and CMS hope to finalize the special terms and conditions of the waiver in the coming months.
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Vermont Publicizes Draft All-Payer Model Waiver
This week, we reviewed the draft waiver agreement between the Centers for Medicare & Medicaid Services (CMS) and the Governor of Vermont, the Green Mountain Care Board (GMCB), and the Vermont Agency of Human Services (AHS) to form an all-payer accountable care organization (ACO) model in Vermont. The agreement, if approved by all parties, would implement ACO assignment targets, outcomes and quality milestones, and would require Vermont to keep all-payer and Medicare-specific total cost of care growth per beneficiary below annual growth rate thresholds. The all-payer model (APM) encourages alignment across Medicare, Medicaid, and commercial payers, moving toward next generation ACO models with all-inclusive population-based payments. Vermont and CMS have reached preliminary agreement on the draft waiver, with state and federal officials conducting further review at this time.
澳门六合彩 Behavioral Health Expertise on Display at Conferences
Our diverse, interdisciplinary behavioral health team has extensive clinical, policy, operations and funding expertise in mental health and substance use disorder prevention and treatment. Recently members of our behavioral health team shared their expertise at two notable conferences.
TeleHealth Services 鈥� Spotlight on Econsults
澳门六合彩 principals Greg Vachon, MD, MPH, and Jean Glossa MD, MBA, provide an overview of econsultations. Greg and Jean define econsults and provide an overview of the spectrum of econsult services in place today, evaluate the benefits and challenges of econsults, and look at recent developments in the econsult market.
澳门六合彩 Conference on Integrated Delivery Is Just a Month Away, More than 200 Already Registered to Attend
This week, we are providing an update on 澳门六合彩’s inaugural conference on , October 10-12, 2016, at The Palmer House in Chicago. More than 200 industry leaders have already registered to attend, including top executives from hospitals, health systems, clinics, provider practices, community-based organizations, and Medicaid managed care plans. Featuring 37 high-level industry speakers, conference panels and breakout sessions are designed to inspire discussion about real-world approaches to helping provider organizations improve the health status of patient populations, lower costs, and ensure a more satisfactory patient experience. Visit the conference website at for complete details.
Texas Submits Uncompensated Care Evaluation to CMS
This week, we reviewed the independent evaluation of Texas’ Uncompensated Care Pool submitted to the Centers for Medicare and Medicaid Services (CMS) by the Texas Health and Human Services Commission (HHSC). The evaluation, which was required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, was completed by 澳门六合彩 (澳门六合彩).
Illinois Releases Draft 1115 Waiver for Behavioral Health Redesign
This week, we reviewed the draft Section 1115 Research and Demonstration waiver, released on August 26, 2016, by the Illinois Department of Healthcare and Family Services (DHFS). The 1115 waiver is proposed as part of the state鈥檚 broader initiatives around the State Innovation Model (SIM) design grant awards, the State Health Assessment (SHA), and the State Health Improvement Plan (SHIP), with goals of strengthening the state鈥檚 behavioral health care system, reducing silos in behavioral health care, and promoting greater integration of physical and behavioral health. The waiver specifically proposes the inclusion of a package of new benefits for individuals with severe mental illness (SMI) and substance use disorders (SUD), as well individuals nearing release from the Illinois Department of Corrections (IDOC) and Cook County Jail systems. DHFS estimates $1.2 billion in federal savings over the five-year waiver term, equaling a 2 percent spending reduction across all Medicaid spending compared to without-waiver spending estimates. DHFS is accepting comments on the draft 1115 waiver through September 26, 2016.
Prepare Now: New Codes for Integrating Primary Care and Behavioral Health
Integrating primary care and behavioral health is a central focus in health care delivery reform for many states and payers as they work towards addressing quality and cost containment. Significant research demonstrating the effect of co-morbid behavioral health conditions on overall health outcomes, and the subsequent cost increases, has led to exploring the implementation of new models of care.
澳门六合彩 Tool Helps MCOs Implement Medicaid Managed Care Rules
On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the final Medicaid managed care rules to modernize federal Medicaid managed care regulations. Many of the new rules go into effect July 2017. The hard work of implementing the new Medicaid managed care regulations will fall squarely on the shoulders of states and Medicaid managed care health plans. For managed care plans, they must step up their operational, administrative, and reporting capabilities to accommodate new state oversight requirements across all aspects of the contract performance.
30-plus Speakers Slated for 澳门六合彩 Conference on Integrated Care Delivery
澳门六合彩鈥檚 inaugural conference 鈥淭he Future of Publicly Sponsored Healthcare: Building Integrated Delivery Systems for Vulnerable Populations鈥� is slated for October 10-12 in Chicago. This premier event, presented by 澳门六合彩 and 澳门六合彩鈥檚 Accountable Care Institute, will address key issues facing health systems, hospitals, clinics and provider practices seeking to integrate care in an environment of rising quality and cost expectations. More than 30 speakers have been confirmed to date. Early Bird registration is now open. Click for complete conference details.
澳门六合彩 Authors Explore New Models of Care in Correctional Health
澳门六合彩 Principals Donna Strugar-Fritsch and Linda Follenweider are featured authors in the spring edition of CorrectCare, the magazine of the National Commission on Correctional Health Care (NCCHC).
Based on a presentation at the NCCHC鈥檚 2015 Leadership Institutes, 鈥淎 Call for New Models of Care in Correctional Health鈥� takes a look at components of new primary care models, how they鈥檝e advanced care 鈥� and how they can be used in correctional settings.
MACRA: Will these carrots and sticks work?
The comment period for MACRA proposed rules started a couple of weeks ago and ends June 26, 2016. CMS is to be commended for valiantly translating MACRA legislation into specific rules that will apply at the start of the first performance period scheduled to be January 1, 2017 (wow!). However commendable though, we should all be clear about the inherent problems, of which there are a number. I鈥檒l briefly outline one central problem: behavioral economics.