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In the News: October 4–11

Primary Care Model Focused on Medicaid Patients Begins to Scale

A primary care model implemented by CareMore in 2015 that serves over 18,000 Medicaid patients in Iowa and Tennessee will be scaled to new markets in Washington, DC, New York and Texas. The model involves comprehensive, relationship-based primary care led by multidisciplinary teams that involves oversight and continuous engagement with the patient. Up to 35% of staff compensation is tied to their ability to achieve patient satisfaction, engagement and clinical outcome goals.

Community health workers develop a personal relationship with patients through repeated outreach, helping the organization identify and address barriers to optimal patient outcomes, such as the presence of substance abuse disorders, food insecurity and other social needs. From May 2017 to April 2018, the Medicaid population served by CareMore in Iowa and Tennessee experienced 10%–17% fewer hospital days, a 21% reduction in ED visits and fewer specialist visits than other Medicaid managed care beneficiaries in the same area.

The primary care ecosystem continues to evolve, with innovators challenging provider organizations by balancing consumer preference and cost in ways health systems have not. Sg2 believes that health systems can have a competitive advantage by addressing the most pressing primary care challenges, such as rising consumer expectations and high-cost structures. For further guidance on creatively assembling and tying together the key pieces of primary care, read the recent Sg2 report Low-Acuity Sites of the Future: Reconfiguring the Primary Care Puzzle.


Integrating Disease Management and SDH Could Help Rural Health Care

A recent Commonwealth Fund article discusses the importance of strengthening rural hospitals and developing new access points for rural communities. Over the years, innovative initiatives such as telehealth applications and the availability of nurse practitioners and physician assistants were introduced to ensure access to care for rural clinicians and patients, but despite this, rural health care providers continue to struggle. Since 2010, 87 rural hospitals have closed (mainly in states that have not yet expanded Medicaid), affecting access to care. The article suggests that care models incorporating disease prevention and chronic disease management with social determinants of health (SDH) are critical given the needs of rural communities.

Sg2 believes rural hospitals have expertise in making the most of limited resources, which can be an asset to smart health system partners. There are many emerging models for rural health care, and a larger health system can be a partner in constructing the ideal rural health care model. For more information about how to work with rural hospitals to build a broader System of CARE, read the Sg2 FAQ The Role of a Rural Hospital in a Regional Health System.


Proposed Legislation Increases Funding for Opioid Addiction Treatment

A recent Washington Post article details a bill passed by the Senate that addresses the rising opioid crisis by expanding and reauthorizing federal programs that improve prevention, treatment and recovery efforts. A notable feature of the bill is the change to a decades-old rule prohibiting Medicaid beneficiaries from receiving substance abuse treatment in mental health facilities with more than 16 beds. If approved, coverage would allow for 30 days of residential treatment.

The legislation prioritizes treatment initiatives with increased resources being directed toward recovery centers. If approved, grant programs would provide comprehensive funding for recovery centers offering housing, job training, and mental and physical health care. Congress has already appropriated $8.5 billion for opioid related programs, but this latest piece of legislation would greatly increase funding levels.

In 2015, over 27 million people in the United States reported use of illicit drugs or misuse of prescription drugs. This health crisis is stressing health systems already facing shortages of specialist providers and limited outpatient addiction service facilities. In response, many health systems are partnering with community stakeholders to design solutions that best integrate addiction services into their System of CARE. To learn more about implementing addiction services across the continuum, read the Sg2 FAQ Treating Substance Use Across the System of CARE.

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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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