A strong care coordination program is instrumental in engaging patients in their health outside the care setting and giving them the confidence to make important health decisions. Download this eBook to learn 6 strategies to jump-start your care coordination program to boost revenue, cut costs and enhance the quality of patient care. 

In this exclusive report, IQVIA features the top 30 largest ACOs in the U.S. Under ACOs, decision making is more centralized and controlled. With so much at stake, service providers must understand how to position themselves in the eyes of new and powerful stakeholders. As of February 2018, IQVIA has obtained professional rosters from 636 ACOs representing 281,000 affiliations and organizational rosters from 526 ACOs representing 14,000 affiliations. Learn who the new influencers are to improve your sales and marketing efforts.

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.

eHealth Initiative conducted a series of interviews to gain insight from an industry perspective on the impact of healthcare reimbursement policies on technology. In October and November 2017, twelve executives, primarily from provider organizations and health information networks (HINs), were interviewed for this research project. Executives answered questions that aimed to establish how policies, consumerism, and patient engagement strategies influence provider decisions around the acquisition and usage of technology, while also affecting revenue.

February 2018 highlights from Manatt Insights

The Departments of the Treasury, Labor, and Health and Human Services (the “Departments”) have proposed regulations to promote the sale of short-term, limited-duration insurance.

Article from Dunn, Margaritis, and Anderson (2017)

While grounded theory is often cited in the qualitative literature as the methodology, there are few good
examples of publications that follow the principles of grounded theory and result in an actual theory. The
purpose of this paper is to demonstrate how the Corbin and Strauss (2015) method of grounded theory was
used in a study looking at how patients with cardiovascular disease and diabetes develop health literacy skills
that are used to manage their condition. The key principles of grounded theory include theoretical sampling,
constant comparison, open, axial, and selective coding, the use of memoing, and theoretical saturation. Data
collection in this study was in the form of semi-structured interviews of 16 patients with cardiovascular
disease and diabetes, and 19 healthcare professionals that care for or educate these patients. Patients were
recruited from a primary care medical practice, a cardiology medical practice, patient focused programs
provided by the American Heart Association, and social media. Healthcare professionals were recruited from
the medical practices, the American Heart Association, and social media. Each interview was recorded,
transcribed, and coded. Insights from these interviews led to the development of the health literacy
instructional mode, which explores the use of digital tools, instructional approaches, social support, and selfdirected
learning in the development of health literacy skills, and is an example of the use of grounded theory
in cardiovascular research.

Literature review from Dunn and Milheim (2017)

The purpose of this paper is to: a) define how informal patient education manifests itself in healthcare settings, b) identify, through a review of literature, potential issues arising from informal patient education practices, and c) suggest ways nurses can further support and enhance informal patient education to help overcome these issues.

Health Literacy Instructional Model from Dunn, Margaritis, Conard, Astano, Volland

Chapter 1: Health literacy in patients with cardiovascular disease and diabetes
Chapter 2: Approaches to building health literacy 
Chapter 3: The Health Literacy Instructional Model 
Chapter 4: Health literacy assessment 
Chapter 5: Building health literacy skills 
Appendix A: Key terms 
Appendix B: Health literacy assessments 
Appendix C: Behavioral approaches