Today, the Centers for Medicare & Medicaid Services (CMS) awarded $8.6 million in funding to 30 states and the District of Columbia to provide State insurance regulators with the opportunity to enhance States’ ability to strengthen their respective health insurance markets through innovative measures that support market reforms and consumer protections under the Patient Protection and Affordable Care Act (PPACA). States can use the funds for activities such as:
Conducting economic analyses and market scans of the State’s health insurance market to improve and expand the number of affordable healthcare coverage options under new flexibilities offered to states by CMS guidance and regulations; and
Examining plan policies, procedures and claims related data related to access to mental health and substance use disorder treatment services, including opioid treatment services.
“These grants build on CMS’s ongoing efforts to give states the tools and flexibility they need to help people struggling to afford the year over year premium increases caused by Obamacare regulations,” said CMS Administrator Seema Verma. “We recognize that States are in the best position to assess the needs of their consumers and develop innovative measures to ensure access to affordable health coverage. These grants make yet another down payment on our work to enhance States’ ability to stabilize and improve their respective health insurance markets.”
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In the next 18 months, 150 million Medicare beneficiaries (active, archived, or deceased) will be transitioned to new ID numbers, called Medicare Beneficiary Identification (MBI) codes. The goal – to protect a vulnerable population from identity fraud – is admirable and urgent.
But the sheer magnitude of the process, combined with significant uncertainties about its rollout, should be of great concern to health IT leaders at hospitals and healthcare systems. Hiccups in the transition could potentially disrupt continuity of care and delay payments to providers. Health IT leaders would be well-served to develop a strategy now to minimize negative impacts down the road.
Why the change is needed
Up until now, Medicare beneficiaries have been using 11-character codes called Health Insurance Claim Numbers (HICN). The problem is that they all begin with the member’s social security number, with two characters added to the end. These ID numbers are easy to crack and – since Social Security numbers provide access to all sorts of private information – leave beneficiaries open to identity theft, both medical and financial. A Medicare card that is lost, copied, or even left in view in a public area or in the home could jeopardize a member’s personal health information or life savings.
So as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare and Medicaid Services (CMS) will be replacing the old Health Insurance Claim Number (HICN) on Medicare cards with new, randomly generated Medicare Beneficiary Identification (MBI) codes. Officially, the change is known as the Social Security Number Removal Initiative. The new MBI codes will use a randomly generated combination of letters and numbers, similar to the recommended best practices for passwords.
Rebecca Bruno, MPM, Director of Policy and Regulatory Affairs, Cognosante
Person-centered approach
Many individuals enrolled in Medicaid also access services from other state human services agencies and community-based providers. Deploying a “whole person” approach for enrollees – supported by modern tools and one-to-one support – can increase beneficiary engagement while lowering a state’s overall costs and administrative burden.
The Medicaid landscape is changing
Since implementation of the Affordable Care Act (ACA) in January 2014, Medicaid enrollment has been steadily increasing. As of August 2016, the latest period for which data is available, more than 73 million Americans were covered by Medicaid.[i] This is approximately a 28 percent increase from the enrollment period just prior to the first Marketplace Open Enrollment period in October 2013.[ii] In addition to Medicaid’s traditional coverage of low-income families, low-income elderly individuals, and individuals with disabilities, in many states Medicaid now covers adults without dependent children. Also, more Medicaid beneficiaries in need of long-term services and supports (LTSS) are being served in home and community-based settings rather than nursing homes and institutions.
AMGA applauded the Centers for Medicare & Medicaid Services’ (CMS’) decision to not move forward with the Medicare Part B Drug Demonstration.
In May, AMGA submitted comments to CMS outlining concerns that the proposal could hinder beneficiary access to needed medications while doing little to improve quality.
“AMGA appreciates that the administration considered stakeholder feedback from AMGA and others and will not move forward with this proposal,” said Donald W. Fisher, Ph.D., CAE, AMGA’s president and chief executive officer. “AMGA supports the transition to value-based payment and looks forward to working with the current and incoming administration on building a healthcare system that truly rewards quality of care, reduces cost, and advances population health.”
Today, the Centers for Medicare & Medicaid Services (CMS) released a tool to share automatically electronic data for the Medicare Quality Payment Program. This new release is the first in a series that will be part of CMS’s ongoing efforts to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients.
In October, CMS released the Quality Payment Program website, an interactive site to help clinicians understand the program and successfully participate. Today’s release, commonly referred to as an Application Program Interface (API), builds on that site by making it easier for other organizations to retrieve and maintain the Quality Payment Program’s measures and enable them to build applications for clinicians and their practices. The API, available at qpp.cms.gov/education, will allow developers to write software using the information described on the Explore Measures section of QPP.cms.gov. Based on interviews with clinicians, CMS created the Explores Measures tool, which enables clinicians and practice managers to select measures that likely fit their practice, assemble them into a group, and print or save them for reference. Already, tens of thousands of people are using this tool.
Dr. Kate Goodrich, Director of the CMS Centers for Clinical Standards and Quality said, “The API released today will continue CMS’s focus on user-driven design by providing developers and our partners the opportunity to turn our data into powerful applications. CMS is committed to collaborating with the organizations that doctors trust to make their lives easier, while supporting their efforts to improve the quality of care across America.”
April York, Senior Director of Patient Financial Services, Novant Health
Craig Webster, Chief Information Officer, ClearBalance
It’s no secret that high-deductible health plans have drastically altered the reimbursement landscape. Essentially, we operate in a two-payer world. Centers for Medicare & Medicaid Services and private payers represent one arm of collections, while increasingly patients are a secondary – and critical – payer arm themselves. Revenue cycle processes should tune revenue cycle workflows to engage patients in financial counseling up front so they understand their portion of the care cost and the financing options available.
A few years ago, Novant Health, which is a multi-state integrated delivery network, needed to combat the upswing in high deductible health plans (HDHPs) that ultimately transfer more financial burden to consumers. Novant Health has seen an increase in patients with HDHPs for more than six years. Today, it’s not unusual for patients to have $5,000 to $10,000 deductibles.
Informed patients have lower readmission rates, better therapy adherence and reduced miscommunication errors among providers, outlining the critical need for providers to share patient data and engage with patients. Historically, such initiatives have often failed or have been underutilized. Nevertheless, the need and desire for patient engagement programs have increased in recent years, partially due to quality programs introduced with value-based care requirements, but also because of improvements and innovation in digital and mobile technology.
In determining the right way to engage patients, it is important to first examine previous initiatives and why they were unsuccessful. Under Meaningful Use, for example, five percent of patients were required to view and download their records. Many providers had a hard time meeting this requirement, and in order to comply, many resorted to patient rounds, traveling bed-to-bed, to request patients to download their records.
Many other initiatives have leveraged patient portals in efforts to increase engagement. When using such portals, patients are often faced with confusion surrounding the correct one to use – a hospital-specific portal, the primary physician’s portal, the surgeon’s portal or the payer’s portal? According to one client, portal usage statistics reveal patients are really only using them for financial information and not on a regular basis to manage care.
Mary Kay Thalken, RN, MBA, Chief Clinical Officer, Ensocare
Healthcare organizations have long struggled with care transitions, especially when moving complex patients who require multifaceted care from acute settings to a post-acute environment. These transitions are often fraught with communication breakdowns, poor information exchange and slow responses to changing patient conditions. As a result, patients frequently don’t receive the care they need, or that care is delayed, causing them to end up back in the hospital. According to the Centers for Medicare & Medicaid Services (CMS), nearly 20 percent of Medicare patients discharged from a hospital are readmitted within 30 days, at a cost of more than $26 billion every year. Not only do inadequate transitions have ramifications from a cost perspective, they also negatively affect patient satisfaction and the overall patient experience.
Left unchecked, the issue of poor care transitions will continue to decline as the population ages. In fact, it is estimated that by 2030, one in five U.S. residents will be 65 years or older, and since older patients are more apt to visit the hospital and require post-acute care after discharge, it is becoming even more critical for these care transitions to be smooth and seamless.
Insufficient communication is the main reason why care transitions break down. When organizations do not have processes and systems in place to facilitate consistent information exchange, important data can be lost, increasing the risk for potential issues that could occur. Additionally, it is estimated that 80 percent of serious medical errors are attributable to miscommunication during hand-offs, and these communication deficits often lead to poor, if not detrimental outcomes.
Megan Renfrew, Director of Health Policy and Regulatory Affairs and Policy Team Lead, Cognosante
The “mega” Medicaid managed care rule released this spring by the Centers for Medicare and Medicaid Services (CMS) set in motion a long-overdue overhaul of managed care programs in Medicaid and the Children’s Health Insurance Program. As managed care plans oversee larger percentages of enrollees and benefits, the pressure on state Medicaid agencies to ensure that those plans are providing quality services for a good value increases, as does the need to ensure program integrity is maintained.
The Medicaid managed care rule improves beneficiary protections, increases the focus on quality of care, strengthens financial management and program integrity efforts, and provides states with support for delivery and payment system reform efforts within managed care (e.g. value-based purchasing). In addition, this rule strengthens data submission and reporting requirements to support program oversight, program integrity, and increased transparency.
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As part of our efforts to improve care delivery, payments to providers, and the sharing and utilization of information, the Centers for Medicare & Medicaid Services (CMS) today released a privacy-protected public data set, the Hospice Utilization and Payment Public Use File (Hospice PUF), which provides information on services provided to Medicare beneficiaries by hospice providers. CMS also released an update to the Market Saturation and Utilization Data Tool, formerly called the Moratoria Provider Services and Utilization Data Tool. For the first time, this tool will include information on hospice services.
“The Hospice data and Market Saturation and Utilization Data Tool made available today support our goals of increasing access to Medicare data and improving the flow of information,” said CMS Chief Data Officer Niall Brennan. “CMS believes that greater data transparency leads to a more effectively functioning health care system, which leads to better care and smarter spending.”
