ACOs Moving Into Medicaid

Accountable care organizations, one of the centerpieces of recent Medicare efforts to test new ways to deliver care more effectively and at less cost, are finding their way into state Medicaid programs as well.

Today, a dozen states employ Medicaid ACOs and another ten are planning to do so.

Learn more about Medicaid ACOs, and how one state (Minnesota), in particular, is using them, in this Kaiser Health News report.…

Amid Budget Woes, States May Look to Medicaid for Savings

Budget challenges may lead some states to seek changes in their Medicaid programs aimed at saving money.

Or so reports Fitch Ratings, the bond rating company.

According to Fitch, health care was the biggest driver in rising state spending between 2005 and 2015 and the portion of state spending on health and social services will increase from 30.7 percent in 2015 to 38.3 percent in 2025.

Among the measures states will turn to in an effort to manage rising health care costs, according to Fitch, are Medicaid work requirements, reductions in Medicaid retroactive coverage, new Medicaid premiums, and lifetime limits on Medicaid benefits.

Learn more about the challenges facing state governments in the coming years in this Fitch news release and this summary on the Healthcare Dive web site.

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Verdict: Medicaid Expansion Improved Care and Access

A new review of studies published since the Affordable Care Act’s Medicaid expansion has concluded that expansion improved care, access to care, and coverage in states that expanded their Medicaid programs.

Among the improvements cited by studies are:

  • greater use of primary care
  • more preventive health visits
  • more behavioral health care
  • shorter hospital stays
  • fewer avoidable hospital admissions
  • reduced access problems
  • reduced reliance on hospital ERs as a primary source of care
  • improved monitoring and compliance rates for patients with diabetes and hypertension
  • higher rates of screening for prostate cancer and Pap smears

In addition, hospitals provided less uncompensated care and had better margins.

Learn more in the Health Affairs study “The Effects Of Medicaid Expansion Under The ACA:  A Systematic Review,” which can be found here, or go here for a Healthcare Dive summary of the study.…

CMS Reports on Medicaid Long-Term Care Spending

The Centers for Medicare & Medicaid Services has issued a report on FY 2016 spending for Medicaid-covered long-term services and supports.  The highlights of the $167 billion in state and federal spending include:

 

  • Home and community-based services have accounted for almost all Medicaid long-term services and supports growth in recent years.
  • Home and community-based services spending increased 10 percent in FY 2016, greater than the five percent average annual growth from FY 2011 through 2015.
  • Institutional spending remained close to the FY 2010 amount.
  • Institutional service spending decreased two percent in FY 2016 following an average annual increase of 0.3 percent over the previous five years.
  • Long-term services and supports provided through managed care continued to grow as states expanded their use of managed long-term services and supports delivery systems.
  • Managed long-term services and supports spending amounted to $39 billion in FY 2016, a 24 percent increase from $32 billion in FY 2015.

Learn more about Medicaid spending and trends for long-term care and long-term services and supports in the new CMS report “Improving the Balance: The Evolution of Long Term Services and Supports, FY 1981-2014,” which can be found here.…

CMS Introduces Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services has unveiled a “scorecard” through which interested parties will be able to monitor outcomes for state Medicaid programs, state CHIP programs, and CMS itself while also comparing the performance of states to one another.

The purpose of the scorecard, according to CMS, is “to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes.”

CMS also explained that

The first version of the Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. The metrics included in the first Scorecard reflect important health issues such as well child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions. The Scorecard represents the first time that CMS is publishing state and federal administrative performance metrics – which include measures like state/federal timeliness of managed care capitation rate reviews, time from submission to approval for Section 1115 demonstrations, and state/federal state plan amendment processing times.

It is not clear at this time how CMS will use the scorecard or what its value might be.

Learn more about the new CMS …