By Emma Walsh-Alker
CHIR had quite a bit to be grateful for this November, together with new well being coverage analysis. For the most recent installment of our month-to-month analysis roundup, we reviewed research on client consciousness of Medicaid renewals resuming when the COVID-19 public well being emergency (PHE) expires, integrating well being fairness into value-based fee fashions, and tendencies in hospital consolidation throughout well being care markets.
Jennifer M. Haley, Michael Karpman, Genevieve M. Kenney, Stephen Zuckerman, Most Adults in Medicaid-Enrolled Families Are Unaware of Medicaid Renewals Resuming within the Future, Urban Institute, November 15, 2022. Under the Medicaid steady protection requirement tied to the COVID-19 PHE, state Medicaid companies are prohibited from disenrolling beneficiaries during the PHE as a situation of receiving elevated federal funding. Using knowledge from their June 2022 Health Reform Monitoring Survey, researchers on the Urban Institute evaluated the extent to which adults aged 18-64 who’re both enrolled in Medicaid or have a member of the family enrolled in Medicaid or CHIP are conscious of this upcoming change.
What it Finds
- The majority (62 p.c) of the adults surveyed had heard “nothing at all” in regards to the resumption of Medicaid renewals.
- Only 5 p.c of the survey group had heard “a lot” in regards to the renewals, with the remainder of respondents listening to “some” (16.2 p.c) or “only a little” (15.7 p.c).
- More than half (56.5 p.c) of grownup respondents who enrolled in Medicaid after the continual protection requirement started had heard nothing about renewals resuming.
- Respondents who had heard something in regards to the upcoming renewals reported acquiring this data from a wide range of sources.
- The largest share of those respondents (34.3 p.c) indicated they obtained data from a media supply together with TV, social media, radio, or a newspaper. The subsequent largest share of the group (30.6 p.c) obtained data from a state company. About 1 / 4 (24.5 p.c) of respondents conscious of renewals resuming obtained data from a well being insurer or plan, whereas 17.8 p.c discovered from a well being care supplier, and 6.5 p.c heard from one other supply.
- Half (50.4 p.c) of respondents conscious of upcoming renewals reported receiving a discover that they might want to renew their protection. Other frequent messages obtained included a request to replace contact data (reported by 36.4 p.c of the group) or confirm eligibility data reminiscent of revenue (34.4 p.c).
- Fewer respondents on this group have been knowledgeable about different protection sources obtainable to them if they’re decided not eligible for Medicaid (29.1 p.c) or the right way to entry client help in the course of the renewal course of (21.3 p.c).
Why it Matters
With the PHE lately prolonged into 2023, stakeholders proceed to put together for the huge wave of protection transitions anticipated to happen as soon as Medicaid renewals resume. Low ranges of client consciousness in regards to the upcoming resumption of Medicaid renewals are a trigger for concern as stakeholders search to reduce protection losses. While sources reminiscent of social media and information broadcasts could also be reaching the widest viewers, there are nonetheless alternatives for state companies and well being plans to conduct extra individualized outreach relating to potential modifications to an enrollee’s protection, and steps they’ll take to replace their data earlier than renewals resume. Providing sources on inexpensive various protection choices and connecting individuals to enrollment assisters shall be particularly essential for the 15 million people projected to lose Medicaid, lots of whom shall be eligible for sponsored marketplace protection.
William Ok. Bleser, Yolande Pokam Tchuisseu, Humphrey Shen, Andrea Thoumi, Deborah R. Kaye, and Robert S. Saunders, Advancing Equity Through Value-Based Payment: Implementation And Evaluation To Support Design Goals, Health Affairs, November 4, 2022. Value-based fee (VBP) fashions tie supplier reimbursement to high quality metrics, value financial savings, or each. Researchers accomplished a scan of related coverage and literature to determine finest practices for the design and implementation of equity-driven VBP fashions to provide you with a set of suggestions.
What it Finds
- Researchers advocate that VBP fashions contemplate fairness of their affected person attribution design—how fashions determine a patient-provider relationship—to keep away from excluding marginalized sufferers from collaborating in VBP packages.
- VBP fashions attributing sufferers primarily based on claims knowledge are much less prone to seize sufferers which have fewer encounters with outpatient care settings, however sufferers of coloration usually tend to report having no traditional supply of care than white sufferers for a wide range of causes, together with lack of entry or distrust within the well being care system.
- To stop racial and ethnic biases in affected person attribution, researchers advocate that VBP fashions increase the variety of well being care settings they settle for claims from to incorporate telehealth and inpatient hospital visits.
- Continued concentrate on the right way to eradicate implicit biases in threat adjustment fashions can also be essential to equitable affected person attribution.
- Active outreach to underserved affected person populations is required to extend entry to and engagement with VBP fashions.
- Researchers advocate that VBP advisory boards and focus teams proceed to incorporate representatives from underserved affected person populations.
- Clinicians can function helpful messengers to speak with sufferers a few VBP mannequin and the way it may gain advantage them. Additionally, payers ought to think about using extra extensively accessible outreach strategies reminiscent of textual content messaging to offer details about VBP.
- Cultural competency and “cultural humility”—the apply of understanding the complexities of a affected person’s identification and experiences—needs to be prioritized in all outreach surrounding a VBP mannequin. Payers can undertake high quality measures associated to supplier communications and well being literacy to advertise these objectives.
- VBP fashions ought to foster cross-sector collaboration to deal with social determinants of well being points.
- Researchers spotlight the Accountable Health Communities mannequin, which established monetary incentives for social wants screenings and promoted integration of scientific and group providers.
- Health knowledge alternate networks and built-in expertise platforms can even assist join sufferers to group sources. For occasion, the state of North Carolina pioneered a shared platform referred to as NCCARE360 to attach sufferers with native providers.
- Evaluation of VBP fashions’ efficiency needs to be grounded in equity-based metrics, which require extra strong knowledge assortment.
Why it Matters
By making a monetary incentive for suppliers to deal with social determinants of well being in looking for to enhance care high quality, VBP fashions have the potential to advance well being fairness. However, if these fee fashions are usually not explicitly designed to learn marginalized teams, the concentrate on worth might additionally perpetuate inequities. The Centers for Medicare & Medicaid Services (CMS) lately introduced an up to date Medicare mannequin, “ACO REACH,” which instructs collaborating accountable care organizations to measurably cut back well being disparities of their beneficiary populations starting in 2023. As value-based fee garners continued consideration on the state and federal degree, these suggestions for equity-based VBP design and implementation can inform policymakers and payers initiatives.
Brent D. Fulton, Daniel R. Arnold, Jaime S. King, Alexandra D. Montague, Thomas L. Greaney, and Richard M. Scheffler, The Rise Of Cross-Market Hospital Systems And Their Market Power In The US, Health Affairs, November 2022. Using hospital system knowledge from the American Hospital Association’s annual survey between 2009–2019, researchers look at tendencies in hospital mergers and acquisitions that occurred throughout separate geographic markets and the way shifts in market energy could also be impacting customers. Researchers used city “commuting zones”—a grouping of areas inside which staff usually commute to work, which function a proxy for the place customers journey for hospital providers—to outline the geographic markets by which hospitals take part.
What it Finds
- From 2010 to 2019, 1,500 hospitals joined a hospital system, bringing the proportion of hospitals in a hospital system up 58 p.c in 2009 to 67 p.c in 2019.
- Individual hospitals becoming a member of state hospital methods accounted for almost all of this improve.
- While nearly all of hospital methods owned ten or fewer hospitals in 2019, the most important hospital methods comprised a disproportionate share of hospital possession, accounting for 65 p.c of all hospitals inside methods.
- Within the commuting zones studied, hospital methods had a mean market share of 23 p.c, whereas unbiased hospitals’ market share averaged 13 p.c.
- Hospital methods that owned hospitals in two or extra commuting zones have been categorized as “cross-market,” and will have extra leverage in contract negotiations with payers.
- Of the 368 complete hospital methods working in 2019, 216 methods (59 p.c) have been cross-market methods.
- Researchers recognized hospital methods in city commuting zones with potential “enhanced cross-market power,” or the flexibility to leverage market energy throughout totally different geographic markets throughout contract negotiations with payers. The variety of hospital methods with enhanced cross-market energy elevated by 54 p.c over the research interval, from 37 to 57 methods.
Why it Matters
Hospital methods are increasingly consolidating market energy throughout the nation, usually resulting in greater prices for sufferers. Although cross-market hospital mergers have typically not been deemed anticompetitive as a result of hospitals in several service areas are competing for various affected person populations, authors of this research emphasised that in contract negotiations with payers, hospital methods could leverage energy in a single market to determine greater costs throughout markets (as an illustration, by requiring insurers to contract with a number of hospitals within the system as a situation of their contract with a selected hospital). While some antitrust enforcement motion has occurred relating to cross-market mergers, notably in California, this consolidation pattern and its potential anticompetitive penalties are price monitoring as policymakers search to curb rising well being care prices.