Health Care Matters | November 22, 2024
Rural Health Spotlight
Thursday, November 21st, was National Rural Health Day, an opportunity to reflect on the vital role rural hospitals play in providing care to underserved communities. Check out our latest blog where we explore CMS’s innovative strategies to overcome barriers and improve outcomes for rural health care.
For more on this topic, the Center for Healthcare Quality & Payment Reform recently released reports detailing the financial and operational challenges rural hospitals face, along with solutions to ensure their sustainability. Together, these resources offer valuable perspectives on strengthening rural health care systems.
Post Election Policy Pulse
Trump has announced that he plans to nominate Robert F. Kennedy Jr. to lead the Department of Health and Human Services and Mehmet Oz, MD, to be administrator of the Centers for Medicare & Medicaid Services.
For more insight on the impact of these nominations if confirmed, read the following:
RFK Jr.’s Views on Food, Vaccines, Abortion, and the FDA (Stat News)
RFK Jr.’s Stances on Key Health Issues (KFF News)
Trump Names Mehmet Oz as CMS Administrator (Modern Healthcare)
Biden-Harris Administration Announces Approvals in Five States that will Keep Eligible Children and Adults Enrolled in Medicaid and CHIP
The Biden-Harris administration has approved Medicaid and CHIP amendments for Colorado, Hawaii, Minnesota, New York, and Pennsylvania, allowing extended continuous eligibility for children and certain adults. This policy ensures that children can stay covered beyond the minimum required 12-month limit and offers continuous coverage for those exiting incarceration in Colorado and Pennsylvania. The move is part of the administration’s ongoing efforts to expand health care access and minimize gaps in care, particularly for vulnerable populations.
Read here.
Why It Matters
These approvals represent a proactive approach to protect healthcare access amidst political and administrative changes, ensuring vulnerable populations continue to receive the care they need. With the upcoming change in administration, many states are rushing to secure Medicaid approvals before President-Elect Trump takes office as the new administration is expected to potentially reduce government spending by squeezing state Medicaid budgets and alter policies that currently support expanded coverage.
At the same time, states are working to mitigate the challenges associated with Medicaid unwinding. A Wakely white paper, the first in an ongoing series, highlights state approaches to manage changes in enrollment and acuity with the goal of informing discussions on how changes in these processes impact the cost to provide Medicaid benefits to a changing enrollee base. The approved amendments for continuous eligibility may help mitigate some of the challenges the Wakely team identified by maintaining coverage for those who might otherwise lose it due to administrative hurdles.
State Regulators Admit Errors in Health Insurance Directories but Take Little Action
ProPublica published a deep dive into the persistent use of ‘ghost networks’ in health insurance, where provider directories list physicians and other clinicians who are unreachable, not taking new patients, or are no longer in-network. While state regulations require accurate directories, enforcement of this requirement has been weak and when it is imposed, fines and penalties have been minor. This issue is particularly pronounced for mental health providers, which exacerbates the challenges of finding an available provider for patients with the ongoing workforce shortages in the mental health field.
Read here.
Why It Matters
Addressing the issue of ghost networks is vital for improving access to care, ensuring regulatory compliance, and ultimately enhancing the quality and efficiency of the healthcare sector. Inaccurate provider directories make it difficult for patients to find available providers which can lead to delays in care, worsening health outcomes, and increased burden and frustration to patients. Ghost networks also exacerbate the workforce challenges, particularly in mental health, by giving the false impression that there are more available providers than there actually are, further complicating access to necessary care. Experts quoted in the article state that stricter regulations and stronger fines are needed to protect insurance customers from these errors, which are at the heart of so-called ghost networks.
Where We Are Reading
Barriers to Obtaining and Using Interoperable Information Among Non-Federal Acute Care Hospitals
The authors of this JAMIA article examined barriers for hospitals to exchanging information with other organizations, and how barriers vary by hospital characteristics and methods used to obtain information. Read Here.
When You Prioritize Accountable CareYou Improve Women’s Health
On October 17th, Accountable for Health, the National Partnership for Women & Families (NPWF), and United States of Care (USofCare) co-hosted a virtual Congressional briefing, “Advancing Women’s Health & Patient-First Care Through Innovation & Payment Reform”, making the compelling case for how accountable care can improve outcomes, particularly in women’s health.
Read the blog with key takeaways from the briefing here.
MedPAC November Meeting Slides/Key Takeaways
The Medicare Payment Advisory Committee (MedPAC) hosted its November public meeting and posted the slides and transcripts here. Of note, the Commissioners discussed the A-APM bonus considering if the bonus has meaningfully impacted participation in A-APMs and whether the bonus should be extended. While they did not come to consensus on a recommendation, they are contemplating future work on this topic.
HCP- LAN 2024 APM Measurement Methodology Report
Every year, the Health Care Payment Learning and Action Network (HCPLAN) conducts a national effort to assess the adoption of APMs over time and track progress towards the HCPLAN’s goals. They recently released the 2024 Measurement Efforts results.
Read more here.
New VBC Resource
HCTTF: The Next Frontier - Specialty Integration in Value-Based Care
The Health Care Transformation Task Force (HCTTF) released a resource highlighting case studies and strategies that provide operational insights into how organizations are addressing specialty integration across specialties, model types, and populations.
