The Centers for Medicare & Medicaid Services is seeking public input on a proposal to permit Medicare beneficiaries to enter into direct contracts with primary care and multi-specialty providers.

According to CMS,

A DPC [direct provider contracting] model would aim to enhance the beneficiary-physician relationship by providing a platform for physician group practices to provide flexible, accessible, and high quality care to beneficiaries that have actively chosen this type of care model.

The request for information, issued earlier this week, seeks public input on experience with direct provider contracting and asks interested parties to describe how Medicare might structure such a model, including addressing considerations such as provider and state participation, beneficiary participation, payments, program integrity, and beneficiary protection.

Comments are due May 25.

To learn more about the CMS request for information, a news release describing the request, and a copy of the RFI itself, go here.

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The short-term health insurance plans that the administration proposes making more available to consumers as an alternative to comprehensive health insurance that meets Affordable Care Act coverage requirements may leave consumers with greater out-of-pocket costs and less coverage for some critical services.

According to a Kaiser Family Foundation review of available short-term, limited duration plans in 10 markets across the country, those plans:

• often do not cover mental health and substance abuse services and outpatient prescription drugs
• may turn down individuals or charge them higher premiums based on age, gender, or health status, including pre-existing conditions
• require greater cost-sharing by their purchasers
• do not cover maternity services at all

Such plans are not required to comply with the Affordable Care Act’s essential health benefits requirement.

For a closer look at short-term health insurance plans, how they operate, and what they do and do not cover, see the report “Understanding Short-Term Limited Duration Health Insurance, which can be found here, on the web site of the Kaiser Family Foundation.…

The Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP issues, met publicly in Washington, D.C. last week.

The following is MACPAC’s own summary of its two days of meetings.

The April 2018 meeting began with session on social determinants of health. Panelists Jocelyn Guyer of Manatt Health Solutions, Arlene Ash of the University of Massachusetts Medical School, and Kevin Moore of UnitedHealthcare Community & State discussed state approaches to financing social interventions through Medicaid. In its second morning session, the Commission reviewed a draft chapter of the June 2018 Report to Congress on Medicaid and CHIP on the adequacy of the care delivery system for substance use disorders (SUDs) with a special focus on opioid use disorders.

In the afternoon, the Commission discussed the Centers for Medicare & Medicaid Services (CMS) March 2018 proposed rule changing the process by which states verify that Medicaid fee-for-service provider payment is sufficient to ensure access to care and agreed to submit comments to the agency. The first day of the meeting concluded with a review of the draft June chapter describing the status of managed long-term services …

A new study found that the increase in the number of insured Americans as a result of the Affordable Care Act has resulted in increased utilization of primary health care services.

According to a study by the National Bureau of Economic Research, primary care utilization rose 3.8 percent, mammograms 1.5 percent, HIV tests 2.1 percent, and flu shots 1.9 percent over a three-year period.  The study suggests that preventive care increased between 17 and 50 percent.

The study attributes all of the gains to improved access to private insurance and none to Medicaid expansion.

These results are based on self-reported information gathered from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System.

Learn more about these and other study findings in the National Bureau of Economic Resarch report  “Effects of the Affordable Care Act on Health Behaviors after Three Years” or see this summary on the Healthcare Dive web site.…

In support of its proposal that Medicare adopt a unified payment system for post-acute-care services, the Medicare Payment Advisory Commission is exploring how to develop uniform outcome measures to support such a new payment system.

Under the MedPAC vision, articulated at its early April public meeting, skilled nursing facilities, home health agencies, long-term-care hospitals, and inpatient rehabilitation facilities would see their outcomes quantified based on their performance on a series of quality measures.

Meanwhile, there has been little congressional interest in the unified post-acute payment proposal so far.  While some aspects of such a proposal could be implemented administratively, the comprehensive system would require legislation.

Learn more about the Medicare uniform outcomes measures proposal, the unified post-acute care payment proposal, how they interact, and the prospects for both from this article in Provider magazine.…