Pennsylvania Agriculture Secretary Russell Redding and Department of Human Services Dr. Perri Rosen will be joined by industry and healthcare representatives this afternoon for an open conversation about decreasing stigma surrounding mental health in agriculture. The discussion will be livestreamed on Facebook at 1:00 PM.

“Agriculture is more than a job, it’s a lifestyle led by proud Pennsylvanians,” said Redding. “But farmers are not exempt from the burdens of life. The stresses we all face as we maneuver living through a pandemic are compounded by uncertain markets, droughts and extreme weather and often pressures of running a generations-old farm.

“It’s as simple as reaching out to our neighbors and having honest conversations about mental health,” added Redding. “These small actions can help to break the stigma surrounding mental health in agriculture and build a stronger, healthier agriculture community in Pennsylvania.”

According to a January study by the Centers for Disease Control and Prevention, farmers are among the most likely to die by suicide compared to other occupations. The study also found that suicide rates overall had increased by 40 percent. Time demands, financial issues, fear of losing the farm (and therefore a home), and the uncertainty of both weather and the economy all contribute to the mental health strain on farmers.

“Mental health is integral to good physical health and our overall quality of life, but unfortunately, it can still be challenging for people to talk about openly. This can make people feel isolated and create barriers to meaningful connection and support from those who care about us,” said Human Services Secretary Teresa Miller. “We must all work to build empathetic, supportive communities where people know that they will be heard and validated. Mental health affects all of us, and by recognizing this, checking in on each other, and offering to help, we can make sure people know that they never have to feel alone.”

Secretary Redding encourages farmers to start conversations in their communities and watch for signs of distress, including:

• Decline in care of crops, animals, and farm
• Deterioration of personal appearance
• Withdrawing from social events
• Increase in farm accidents
• Change in routine
• Increased physical complaints
• Increase in alcohol use
• Giving away prized possessions

The Department of Human Services offers free COVID-19 crisis counseling services through the Support and Referral Helpline, anyone feeling stressed, overwhelmed, alone, or anxious is encouraged to connect with a free crisis counselor by calling 1-855-284-2494. For TTY, dial 724-631-5600. Trained professionals are available 24/7 to help navigate unprecedented challenges.

If you or someone you know is experiencing a mental health crisis or is considering suicide, help is available. Reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact Crisis Text Line by texting PA to 741-741.

A Plain Communities Helpline is also available through WellSpan at Philhaven at 717-989-8661. The Plain Communities Outpatient Clinic provides high quality mental health care that is sensitive to the values of the plain sect community.

Medicare Advantage program continues to grow, offering seniors a greater number of plan choices and increased benefits

Ahead of the annual Medicare Open Enrollment, the Centers for Medicare & Medicaid Services (CMS), under the leadership of President Trump, announced today that average 2021 premiums for Medicare Advantage plans are expected to decline 34.2 percent from 2017 while plan choice, benefits, and enrollment continue to increase. The Medicare Advantage average monthly premium will be the lowest in 14 years (since 2007) for the over 26 million Medicare beneficiaries projected to enroll in a Medicare Advantage plan for 2021. Additionally, for the first time, seniors who use insulin will have over 1,600 Medicare Advantage and Part D prescription drug plans to choose from that will offer insulin at no more than a $35 monthly copay beginning in January.

This news comes as the agency releases the benefit and cost-sharing information for Medicare Advantage and Part D prescription drug plans for the 2021 calendar year. Medicare Advantage plans are private health plans that cover all Medicare benefits plus provide additional benefits, while Part D plans are private health plans that provide prescription drug coverage for seniors. Specific highlights include:

• The Medicare Advantage average monthly plan premium is expected to decrease 11 percent to $21.00 (estimated) in 2021 from an average of $23.63 in 2020. Since 2017, the average monthly Medicare Advantage premium has decreased by an estimated 34.2 percent. This is the lowest that the average monthly premium for a Medicare Advantage plan has been since 2007. In some states including Alabama, Nevada, Michigan, and Kentucky, beneficiaries will see average premium decreases of over 50 percent since 2017. The trend of lower Medicare Advantage premiums means that beneficiaries have saved nearly $1.5 billion in premium costs since 2017.
• Beneficiaries will have more plan choices, with about 2,100 more Medicare Advantage plans operating in 2021 than in 2017, a 76.6 percent increase. Overall, beneficiaries can choose from more than 4,800 Medicare Advantage plans during 2021 open enrollment.
• The average number of Medicare Advantage plan choices per county will increase from about 39 plans in 2020 to 47 plans in 2021. This represents an increase of 78.5 percent since 2017. The number of plan options in rural counties has increased to 2,900 in 2021 from about 2,450 in 2020 (about an 18 percent increase), as a result of flexibilities we gave to plans on benefit coverage and building their provider networks.
• Medicare Advantage continues to be popular, with enrollment projected to increase to an all-time high of 26.9 million beneficiaries from current enrollment of 24.4 million. The projected enrollment for 2021 represents a 44 percent increase in Medicare Advantage enrollment since 2017. About 42 percent of beneficiaries are expected to be enrolled in Medicare Advantage for 2021. Starting in 2021, beneficiaries with End Stage Renal Disease will now have the option to enroll in a Medicare Advantage plan, giving them more affordable Medicare coverage choices.
• As previously announced, the average basic Part D premium will be approximately $30.50 in 2021. The trend of lower Part D premiums, which have decreased by 12 percent since 2017, means that beneficiaries have saved nearly $1.9 billion in premium costs over that time. Further, Part D continues to be an extremely popular program, with enrollment increasing by 16.7 percent since 2017.
• Since 2017, beneficiaries have saved approximately $3.4 billion in combined Medicare Advantage and Part D premium costs.

“Once again, President Trump has delivered tangible results for America’s seniors,” said CMS Administrator Seema Verma. “Today’s announcement confirms that market competition works. Historically low premiums, massive savings on insulin, and more supplemental benefits represent the welcome fruit of the creative, patient-oriented policies that this administration has made its calling card. Medicare beneficiaries will feel the difference – in their health as well as their pocketbook.

With over 1,600 prescription drug plans across the nation, for the first time, seniors who use insulin will be able to choose a plan in their area that offers insulin savings through the Part D Senior Savings Model and provides coverage of a broad set of insulins, each for no more than $35 per month. Beneficiaries will be able to find prescription drug plans that are participating in the Part D Senior Savings Model in the 2021 plan year through the Medicare Plan Finder on Medicare.gov during the annual open enrollment period this Fall. CMS will add a new “Insulin Savings” filter to easily display plans that will offer capped out-of-pocket costs for insulin.

Based on flexibilities that the Trump Administration provided Medicare Advantage and Part D plans over the last three years, beneficiaries will continue to have an even greater number of plan choices with new types of extra benefits that aren’t usually covered in traditional Medicare. Highlights of benefits for 2021 include:

• Over 94 percent of Medicare Advantage plans will offer additional telehealth benefits reaching 20.7 million beneficiaries, up from about 58 percent of plans offering telehealth benefits in 2020. In 2019, CMS implemented legislation signed by President Trump to give seniors enrolled in Medicare Advantage plans access to additional telehealth benefits from the convenience of their homes.
• For the first time in Medicare, 53 Medicare Advantage plans will offer increased access to palliative care and integrated hospice care to their enrollees through the Medicare Advantage Value-Based Insurance Design Model.
• More opportunities for seniors to choose from Medicare Advantage plans that provide extra healthcare benefits to keep people healthy. In 2021, about 730 plans will provide about 3 million Medicare Advantage enrollees with these additional types of supplemental benefits, such as adult day health services, caregiver support services, in-home support services, therapeutic massage or home-based palliative care, that are primarily health related under a new interpretation adopted beginning with 2019.

• Expanding access to reduced cost sharing to benefits for enrollees with certain conditions, such as diabetes and congestive heart failure, due to the agency’s reinterpretation of the uniformity requirement in 2018. About 500 plans in 2021 will offer up to 2.5 million Medicare Advantage enrollees with particular conditions with access to lower copayments or additional benefits such as meals and transportation.

• About 920 plans reaching 4.3 million beneficiaries will offer non-primarily health related benefits tailored to people with chronic conditions that may help them better manage their disease(s). Examples of these benefits include pest control, home cleaning services, meal home delivery, and transportation for non-medical reasons such as trips to the grocery store.
• More than 440 Medicare Advantage plans will be participating in the 2021 Medicare Advantage Value-Based Insurance Design Model, with over 1.6 million beneficiaries projected to receive additional benefits such as healthy foods and meals, transportation support, reduced cost-sharing and rewards and incentives aligned with Part D drugs. This represents a nearly a 20 times increase in Medicare Advantage enrollees benefiting from the model compared to 2019.
• CMS will release a request for applications, including for the hospice benefit component, for the Medicare Advantage Value-Based Insurance Design Model 2022 plan year later this fall.

CMS anticipates updating Medicare.gov with the 2021 Medicare Advantage and Part D premiums and cost-sharing information and releasing the Star Ratings for Medicare Advantage and Part D plans in early October. Plan quality has improved in recent years, where in 2020, the average star rating for all Medicare Advantage plans with prescription drug coverage has improved to 4.16 out of 5 stars, increasing from 4.02 in 2017, and the average star rating for a stand-alone prescription drug plan has improved from 3.34 in 2019 to 3.50 in 2020.

Medicare Open Enrollment begins on October 15, 2020, and ends on December 7, 2020. During this time, Medicare beneficiaries can compare coverage options like Original Medicare and Medicare Advantage and choose health and drug plans for 2021. Medicare health and drug plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices and decide on the options that best meet their health needs. They can visit Medicare.gov (https://protect2.fireeye.com/url?k=2bef89ae-77bb90d2-2befb891-0cc47adc5fa2-4ebc25ec3a6b0f2c&u=https://www.medicare.gov/), call 1-800-MEDICARE, or contact their State Health Insurance Assistance Program. People who want to keep their current Medicare coverage do not need to re-enroll.

View this chart on the Medicare Advantage premium change between 2017 and 2020 on a state-by-state basis at: https://www.cms.gov/files/document/medicare-advantage-premium-change-between-2017-2020.pdf.

To view the premiums and costs of 2021 Medicare Advantage and Part D plans, please visit: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html. Select the various 2021 landscape source files in the downloads section of the webpage.

For state-by-state information on Medicare Advantage and Part D in 2021, please visit: https://www.cms.gov/files/document/2021-ma-part-d-landscape-state-state-fact-sheets.pdf.

For more information on the Part D Senior Savings Model, including plan participation, please visit: https://innovation.cms.gov/innovation-models/part-d-savings-model.

For more information on the Medicare Advantage Value Based Insurance Design Model, including plan participation, please visit: https://innovation.cms.gov/innovation-models/vbid.

For a Spanish version of this press release, please visit: https://www.cms.gov/newsroom/press-releases/el-gobierno-del-presidente-trump-anuncia-primas-de-medicare-advantage-historicamente-bajas-y-un.

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 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.

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.