Rural Health Information Hub Latest News

CMMI Director Finds Mixed Results for Bundled Payments, Gives High Marks to Global Budgets

From Fierce Healthcare

Value-based care payment models that focused on a global budget were home runs in a recent Trump administration review, but bundled payment results were more mixed.

Brad Smith, the head of the Center for Medicare & Medicaid Innovation (CMMI) that oversees value-based care payment models, gave during the National Association of Accountable Care Organizations’ fall conference Tuesday details of the agency’s review of the performance of every model.

Some of the winners were ones that had a “clear thesis” about quality and cost improvements, Smith said.

He pointed to Maryland’s Total Cost of Care model as an example. The model sets a per capita limit on Medicare costs in the state.

“Our belief was that if folks had full global budget for their hospital, and even if that total global budget didn’t increase as fast as they would have [liked] that they would be able to manage it,” Smith said.

He said the model was able to generate savings, meet different quality metrics and decrease hospitalizations. The Centers for Medicare & Medicaid Services predicts the model could save Medicare $1 billion by the end of 2023.

Another example was the home health value-based purchasing model, which gives incentives to home health agencies for higher quality care.

“We had a number of quality metrics, and what we believed is that those quality metrics and incentivizing them was tied to a decrease in hospitalization and that is exactly what we saw,” Smith said.

But some payment models had more mixed results. He pointed to some models that had “incredible amounts of transformation but maybe not either the quality improvement or savings improvements we were hoping to see at this scale.”

One example was bundle payment models that combine payments for physicians, hospitals and other providers into a single amount reflecting the total cost of care.

Another example is the oncology care model that ties payments for items such as chemotherapy and other cancer treatments to financial and quality measures.

While bundled payments and oncology were able to see improvements, there were concerns about whether the benchmarks and tiered savings were structured well enough to make the models successful from a financial perspective.

“Instead of us being in a place to say ‘hey, we are ready to scale this model nationally,’ we are having to go back and say, ‘we saw a lot of good things but didn’t do it exactly the way we thought,’” Smith said.

This is bad for the provider that is hoping the model becomes more lasting and can scale and be sustainable over time, he added.

He hopes that CMMI’s new direct contracting model, which starts next April, will help alleviate some of these concerns.

Direct contracting is a set of three different voluntary payment models intended to appeal to a wide range of providers. Some of the models will focus on providers that service Medicare fee-for-service beneficiaries with complex needs or providers that have little experience in Medicare.

The agency aims to do more upfront testing under direct contracting to ensure the financial methodology is sustainable.

“Our hope is that if we can show those savings early on and we don’t have to have direct contracting version 1.0 or 3.0, we can have something that people can count on,” Smith said.

Speaker Pelosi and Secretary Mnuchin Reach Agreement to Fund the Federal Government

Speaker of the House of Representatives Nancy Pelosi and Treasury Secretary Steven Mnuchin reached an agreement on a Continuing Resolution (CR) to provide level funding for the federal government until December 11, 2020 (H.R. 8337). Previously, negotiations had stalled due to partisan disagreements regarding pandemic-related nutrition assistance and farm aid, both of which were included in the final bill. The House of Representatives passed the CR last night; the Senate is expected to quickly consider the bill.

The CR contains changes to the Medicare Accelerated and Advance Payment (MAAP) Programs (Sec. 2501). The bill extends both the period before repayment begins and the period before the balance must be repaid in full, reduces the recoupment percentage, and lowers the interest rate for payments made under the MAAP Programs and comparable programs between the date of enactment of the CARES Act and the end of the COVID-19 public health emergency.

The bill extends funding for Community Health Centers, National Health Service Corps, and the Teaching Health Centers Graduate Medical Education Program through December 11, 2020 (Sec. 2101), extends the work geographic practice cost index floor at 1.0 for localities currently less than 1.0 until December 11, 2020 (Sec. 2201), and delays Medicaid DSH cuts until December 11, 2020 (Sec. 2303).

The full text of the CR can be found here and a section-by-section summary here.

APHA Releases Guide for Racial Equity Webinar Series

The American Public Health Association (APHA) released a discussion guide to be used while viewing the webinar recordings for the “Racial Equity Webinar Series.” The discussion guide includes a summary of each webinar, pre-webinar discussion questions, post-webinar discussion questions, an activity, and resources for each webinar. The webinar series is still ongoing.

Click here to download the discussion guide.
Click here to view the webinar recordings.

University of Pittsburgh Launches HRSA Opioid Training Module

The HRSA Opioid Training Module, “Acute Pain Management Strategies,” was developed at the University of Pittsburgh School of Dental Medicine with funding from the U.S. Department of Health and Human Services Health Resources and Services Administration (PI Dr. Robert Weyant, Co-PI Dr. Deborah Studen-Pavlovich). Content expert Dr. Paul Moore is a dentist, pharmacologist, anesthesiologist, and public health expert who has published over 250 articles in peer reviewed journals and has presented more than 150 invited lectures around the world. He is a renowned expert on local anesthetics, antibiotics, analgesics, sedation, drug interactions, and oral complications of diabetes. In this video, Dr. Moore shares his expertise in acute pain management strategies, responsible opioid prescribing, and alternatives to the routine use of opioids in dentistry.

Click here to watch the video.

Protecting Dental Health Benefits in Pennsylvania

As part of the Pennsylvania Coalition for Oral Health’s (PCOH) adult dental benefit campaign, we are launching some advocacy this fall to protect dental benefits in the state. Working with our consultant, Denny Civic Solutions, and Achieva, we have created a one-pager to use during our communications with decision-makers. If your personal organization or another organization that you are involved in would like to add your logo to the second page of this document, please click the link below no later than Wednesday, September 30th.

We appreciate the consideration.

Click here to download the one-pager.
Click here to contact PCOH to add your logo.



Pennsylvania Nears Launch of New Health Insurance Website

Pennsylvania is getting ready to launch its own website to sell Affordable Care Act-compliant policies that will replace the federally operated to enroll people for the 2021 insurance year, state officials said.

It is named “Pennie” and lawmakers approved the idea last year in a bid to get more people into it, lower their insurance costs and save money for the state government.

Pennsylvanians can sign up for an account on the website after it goes live, scheduled for later this month. Starting Nov. 1 through Jan. 15, shoppers can look for and buy insurance plans on it.

People who have been buying policies in the marketplace will be notified that they must transition to Pennie. State officials say they will begin marketing it to raise public awareness.

Gov. Tom Wolf’s administration has said it expects it can lower premiums by 5% to 10% for the roughly 400,000 people who have been buying policies in the marketplace.

Officials also say they are signing up certified brokers and assisters, and will have customer service centers to help people enroll in plans.

They also say they are spending more money than the federal government to help people enroll and are doing more enrollment activities. They say they will hold enrollment events in each county, with a focus on areas with the highest uninsured rates.

Rural Post-Acute Care Summit Report Released

The National Rural Health Resource Center (The Center), supported by the Federal Office of Rural Health Policy (FORHP), convened a virtual summit of key stakeholders to examine the current state of post-acute care (PAC) in rural America. The COVID-19 pandemic has brought PAC/long-term care (LTC) into the national spotlight, as a significant percentage of pandemic deaths in the U.S. are occurring in LTC and skilled nursing facilities (SNFs). Summit attendees explored issues, challenges, and strategies related to the integration of rural acute and PAC and considered how rural PAC can be successfully included in a population health and value-based payment future.

Focused Topics

Participants engaged in a wide-ranging discussion about current and often longstanding PAC-focused issues and challenges confronting health care organizations and communities across the rural U.S. In particular, the breakout sessions focused on four major topics, identifying both issues and potential strategies and tactical solutions to address those issues.

Identified Common PAC Challenges 

  • Impact of the shifting payment environment from traditional volume-driven fee-for-service and cost-based reimbursement methods to value-based payment arrangements
  • Need to improve access to rural PAC and services
  • Evolving role of technology, particularly the rapid expansion of telehealth in response to the COVID-19 pandemic
  • PAC workforce challenges and opportunities
  • Importance of addressing social determinants of health

Check out the Full Report

This report provides a background on PAC, the Summit participants, process used at the Summit, comprehensive lists of identified strategies and tactics to address high priority rural PAC issues, a discussion on how state Flex Programs can help rural providers address PAC, and a collection of PAC best practices from the field.