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In the News: January 11–18

Community Partnerships Can Help Integrate Health-Social Services

A recent Commonwealth Fund report outlines major challenges and proposed solutions for social service organizations attempting to partner with health care delivery systems. Utilizing a 4-dimension framework (coordination, financial alignment, data and information sharing, metric reporting), the study team performed in-depth interviews and web surveys to evaluate the challenges of addressing high-need and high-cost community health demands.

The team identified 5 challenges—sustainability, measuring outcomes and cost savings, shared savings, data and technology expertise, and cross-sector workflow evidence base—proposed solutions for each and developed a community playbook to guide these efforts.

Strategic community partnerships are becoming increasingly important as health systems initiate efforts in population health. For community partnership examples, including case studies (pages 22–23), read the Sg2 report, Strategic Partnerships for Tomorrow’s Health Care.


Testing Medicaid Eligibility Work Requirements Is Now Allowed

CMS released a memo announcing the federal government will allow states to test work requirements for eligibility in Medicaid programs.

The memo details exclusions from the new work requirements, such as children and people being treated for opioid abuse, and offers suggestions as to what counts as “work,” which can include job training, volunteering or caring for a close relative. “We see moving people off Medicaid as a good outcome because that means they do not need the program anymore and have transitioned to a job or can afford insurance,” CMS administrator Seema Verma said. “This policy helps people achieve the American dream.”

States continue to have greater flexibility to change what is covered through benefit design, who is covered through eligibility levels and how coverage is funded for Medicaid. To learn more about the impact of deregulation, watch the Sg2 on-demand webinar, Payment and Policy Update 2017.


Maryland’s All-Payer Hospital Model Has Been Extended

CMS has extended Maryland’s All-Payer Hospital Model contract through 2019. Under this model, Medicare, Medicaid, commercial and self-pay payers spend the same amount for the same services at the same hospital.

Launched in 2014, this model requires the state to limit its annual all-payer per capita total hospital cost growth while committing to performance goals and fixed annual budgets. A proposed model currently under review, known as the Total Cost of Care All-Payer Model, would expand this initiative to other care settings in 2020.

Health systems will continue to face strategic questions regarding the long-term financial viability of their hospitals due to rising costs, an eroding payer mix and the ongoing shift of inpatient procedures to outpatient facilities. To learn more about the long-term outlook for hospitals, read the new Sg2 report, High-Acuity Facilities of the Future: Redefining Hospital Demand.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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