3/30/18 article by Richard Hartunian, Jacqueline Wolff, Joel Ario, Jocelyn Guyer, Sandy Robinson, Andrew Case, and Robert Rebitzer

The nation's opioid epidemic claimed more than 42,000 lives in 2016 and experts fear it will get worse before it gets better. What can be done to combat this multi-faceted threat to public health? This article looks at how the crisis began, reviews how four sectors have responded, and considers what might bring the crisis under control.

Presentation slides from Dana Richter, Office of  Senator Shelley Moore Capito​, from eHealth Initiative’s Executive Advisory Board on Privacy and Security on May 1, 2018.

Presentation slides by CRISP at eHealth Initiative’s Executive Advisory Board on Privacy and Security on May 1, 2018.

To manage the costs of Medicaid, states are increasingly interested in contracting with managed care organizations (MCOs) to deliver healthcare services to Medicaid beneficiaries. eHealth Initiative (eHI) and Foundation recently conducted interviews with executives from leading Medicaid MCOs to better gauge their progress in developing and implementing clinical data strategies.

Join eHI for a webinar featuring industry leaders who will review the results of the interviews and share real world examples of how MCOs are using clinical data to support their physician networks, manage risk, and improve their members’ care.

Our panel will discuss:
-Common sources of clinical data collected by MCOs
-Transitioning from a culture of claims data to a culture of clinical data
-The biggest challenges faced by MCOs in the collection, use, and exchange of clinical data
-The role that clinical data plays in value-based contracts and in managing performance risk of networks against value-based payment goals

Panelists:
-Gary Christensen, General Manager, States — Public Sector, InterSystems
-John A. Johnson, MD, MBA, FACP, Chief Medical Officer, Virginia Premier Health Plan, Inc.

eHealth Initiative conducted six interviews with executives from leading Medicaid Managed Care Organizations to better gauge MCOs’ progress in defining and implementing their clinical data strategies. Executives were asked about their organization’s main sources of clinical data; progress related to collecting, storing, and sharing clinical data; and about leveraging clinical data for various processes. Interviews revealed the ways clinical data is used in case management systems and value-based contracts with states and provider networks. Read the full report.

The Center for Medicare & Medicaid Innovation (CMMI) is now in its second year of implementation of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model test, a pilot project measuring the potential for value-based insurance design (VBID) in the Medicare Advantage program. In the model test, participating Medicare Advantage Organizations (MAOs), which ordinarily offer Medicare Advantage and Part D benefits to each of their plan enrollees at the same level of uniform coverage and cost sharing, can offer extra coverage or reduced cost sharing to enrollees with CMMI-specified chronic conditions.
 
Manatt Health Strategies analyzed which MAOs are participating in the VBID model test in 2018 and what value-based approaches are being used in their individual plans (also known as plan benefit packages (PBPs)) for which disease conditions. Our findings for CY 2018 show that MAOs generally preserved their approaches from 2017, and continue to focus on diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and hypertension (HPN). Additionally, participating MAOs are mostly reducing cost sharing for medical benefits as their key VBID approach, occasionally in combination with extra coverage of services or reduced cost sharing for Part D drugs. These data give insight into how other MAOs may approach VBID in 2019, when CMS makes the flexibility available to MAOs nationwide.

The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet only 1 in 5 people suffering from an OUD receive treatment. The federal government has responded to the crisis by declaring a public health emergency and making over $500 million of OUD-targeted funding available to states last year. While critical, these dollars (and the programs they fund) pale in comparison to the scale and scope of resources the Medicaid program brings to states to combat the opioid epidemic and other substance use disorders (SUD). Indeed, today, Medicaid covers more than 1 in 3 people with an OUD, and program spending for people with an OUD in 2013 (before Medicaid expansion in many states) was more than $9 billion.

While recent federal efforts to provide OUD-specific grant funding are an essential contribution, the profound economic and social consequences of addiction require substantial and sustained investment in coverage and treatment through the Medicaid program. In short, Medicaid is an existing, robust and stable base from which states are battling, and will continue to battle, the opioid epidemic and SUD issues more broadly. This is particularly true in states that have expanded Medicaid; Medicaid expansion enables these states to provide a wider range of services to a larger group of people suffering from an OUD.

In an issue brief prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, Manatt uses data from three states—New Hampshire, Ohio and West Virginia—to highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.

This regulatory calendar provides an overview of select Department of Health and Human Services (HHS) rules – and one Department of Homeland Security (DHS) rule – that the Administration anticipates releasing over the course of 2018. The calendar is based on the Fall “Unified Agenda of Regulatory and Deregulatory Actions” (or, the “Unified Agenda”), 1 and advancements in rule-making since the Unified Agenda’s release. The Unified Agenda provides a useful overview of rules that agencies anticipate issuing over the next year – including a very high-level summary of the topic of the rule – but it is neither allencompassing nor an exact calendar of how rule making will unfold. Inevitably, promulgation of certain rules will follow a timeline that departs from the Unified Agenda, and rules that were not indicated in the Unified Agenda will be released. Outside of the rule-making process, agencies will advance certain priorities via guidance that is neither subject to the rule-making process nor indicated in the Unified Agenda (and therefore not reflected in this calendar). Rules that raise significant policy issues or that exceed a certain economic threshold must be reviewed by the Office of Management and Budget (OMB) prior to their publication. OMB’s website reflects rules that are under review (but not the content of the rules) and can be a tool to estimate timing of public release, although review times vary significantly.

Manatt will update this calendar to reflect adjustments to timelines that agencies make in the Spring Unified Agenda, which is typically released in late May.

Presentation slides from 3/21/18 webinar.

eHealth Initiative interviewed senior executives at leading healthcare organizations to determine how policies, consumerism, and patient engagement strategies influence provider decisions. In this webinar, we will hear how the decision to acquire and use technology ultimately affects the revenue cycle.

This webinar will dive into:

• Value-based care trends and the impact on technology
• The role of patient engagement in technology decisions
• Adoption of technology
• Pre-Service innovations

Panelists:

Jeff Chester
Senior Vice President and Chief Revenue Officer for Availity

Taya Mohesier
Director of Health Policy & Product Development, H3C

Charlotte Hale
System Director Admission Services and Central Access, Cox Health