In the News: Jul 5–12

Medicaid Expansion Helps CHCs Improve Access

A recent Health Affairs article describes retrospective study findings showing Medicaid expansion had a positive effect on community health centers (CHCs)—particularly those in rural areas. Data collected on all CHCs from 2011 to 2015 suggests Medicaid expansion was associated with an 11.4% decline in uninsured patients seeking care at CHCs. Additionally, improvements in quality measures such as increased body mass screening, follow-up appointments for asthma and hypertension management were reported. These gains were not observed in urban CHC expansion states, suggesting the need to preserve expansion policy and continue targeted approaches based on population needs.

Sg2 believes that health systems can partner with Federally Qualified Health Centers (FQHCs) to improve access to specialty and complex care for traditionally underserved communities. To learn more about how health systems and FQHCs can leverage the strengths of their partner members, read the Sg2 FAQ Partnering with Federally Qualified Health Centers.

CMS Extends Deadline for BPCI Advanced Participation

CMS announced it will be extending the deadline for providers to participate in the Bundled Payments for Care Improvement (BPCI) Advanced model to August 8. The original August 1 deadline was extended after multiple hospitals expressed concern that they didn’t have the claims data necessary to determine whether they wanted to participate.

Under BPCI Advanced, CMS will pay a fixed price for an episode of care, and providers will make money if they keep total costs below a benchmark price, discounted by 3%. Savings payments will be adjusted based on performance on 7 quality measures. Additionally, providers will be at risk for up to 20% of costs exceeding the target price.

BPCI Advanced and other alternative payment models require organizations to align care delivery to keep the total cost of an episode of care down. To learn more about how organizations can utilize common physician alignment models to best position themselves for success in bundled payment models, check out the Sg2 on-demand webinar Physician Alignment Landscape 2018: Aligning for Bundled Payment Models.

MA Experiment Allows APM Qualification Under MACRA

According to a recent Modern Healthcare article, CMS intends to launch a 5-year demonstration allowing doctors in Medicare Advantage (MA) plans to qualify as participating in an alternative payment model (APM) under the Medicare Access and CHIP Reauthorization Act (MACRA).

Under the proposed experiment, CMS will ask providers about their payment arrangements with MA plans and the number of covered patients and then use that information to determine whether the payment arrangements meet the risk standards to qualify as an APM under MACRA. CMS plans to launch the demonstration this year, pending approval from the White House Office of Management and Budget and a public comment period.

Enrollment in MA plans has grown by 71% nationwide since 2010, now covering one-third of all Medicare beneficiaries. Sg2 expects this growth to continue, making the program a significant revenue source for many organizations. To learn more about strategic options for MA, read the Sg2 report Medicare Advantage: Too Big to Ignore.

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