MHA Today | August 10, 2018

August 10, 2018
MHA Today: News for Healthcare Leaders

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August 10, 2018

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.


Herb Kuhn, MHA President & CEO According to the MO HealthNet Division’s website, the role of the state’s Medicaid managed care organizations is to “coordinate care to help individuals and families stay healthy.” It’s a good goal. The August edition of HIDI HealthStats begins to question whether the state’s MCOs are meeting it.

Last May, the state’s MCOs added 240,000 Missourians to the managed care coverage ledger. Of the approximately 970,000 Missourians enrolled in Medicaid, 711,000 now receive coverage through one of the state’s three Medicaid MCOs. These enrollees include low-income families, children, pregnant women and newborns. The balance of the enrollees — largely individuals in the aged, blind and disabled eligibility categories — are covered through the fee-for-service Medicaid program.

The expansion shifted not only the enrollment numbers but also the balance of patient clinical and behavioral risks between the two populations. The fee-for-service side of the program lost its share of the healthiest, least complicated patients, which MCOs gained. Comparing the performance of care between the two populations is difficult because of the significant diversity in their makeup. However, early analysis offers some very interesting results.

HIDI HealthStats For example, managed care patients have higher rates of emergency department utilization — particularly for behavioral disorders. During the 36-month period leading to statewide expansion of Medicaid managed care, hospital visits for behavioral health by MCO enrollees increased by 64 percent in Missouri, while fee-for-service visits increased 13 percent. Between April 2017 and March 2018 — the first 11 months of expansion — these visits increased 39 percent for MCO enrollees and decreased 12 percent for fee-for-service patients. Overall, between May 2014 and March 2018, Medicaid managed care hospital visits for behavioral health have more than doubled with a 127 percent increase, while the same visits by fee-for-service patients have decreased by 1 percent.

Similarly counterintuitive is the large number of superutilizing MCO enrollees with 10 or more hospital visits during the first year of expansion. Utilization reduction opportunities among the most frequent ED patients are well established. And, care management should be central to the delivery of better health and cost control. However, in the 12 months after expansion, the cost concentration curve for Medicaid patients in Missouri did not bend, despite the growth in MCO enrollment.

HIDI HealthStats Medicaid managed care is growing throughout the nation. However, there’s scant evidence that MCOs are delivering value for taxpayers, patients or providers through better health, better care or lower costs. As additional data becomes available, the case likely is to strengthen that MCOs capture rather than create value. In other words, effectively managing and coordinating care will move the system toward the triple aim of health care. Constraining utilization to shift costs from shareholders to patients and providers will carry the opposite effect.

The results are emerging. It’s time for real accountability.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Proposes Rule To Shorten Time For Medicare ACOs To Operate Without Risk
AHA, CHI And MGH Secure ICD-10 Codes For Human Trafficking; New Resources Available

Regulatory News
the latest actions of agencies monitoring health care

CMS Proposes Rule To Shorten Time For Medicare ACOs To Operate Without Risk

Staff Contact: Andrew Wheeler or Brian Kinkade

The Centers for Medicare & Medicaid Services issued a proposed rule to overhaul the Medicare Shared Savings program. The redesigned program, called Pathways to Success, will shorten the time from six years to two years that Accountable Care Organizations can operate under the program without taking risk. The shortened standards would apply to ACOs with participation agreements beginning July 1, 2019. Existing projects that expire at the end of 2018 will receive a six-month renewal to transition to the new program design. The proposed rule also includes provisions relating to beneficiary engagement, quality reporting and program integrity. The rule will be published on Friday, Aug. 17. Public comments on the rule will be accepted through Wednesday, Oct. 17.

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AHA, CHI And MGH Secure ICD-10 Codes For Human Trafficking; New Resources Available

Staff Contact: Sarah Willson or Jackie Gatz

Twenty-nine new ICD-10 codes will be available on Monday, Oct. 1, to allow providers to identify and assist victims of human trafficking, as well as to allow coding professionals to translate that information into data that will provide greater insight into the problem. The American Hospital Association’s Hospitals Against Violence initiative, in collaboration with Catholic Health Initiatives and Massachusetts General Hospital's Human Trafficking Initiative and Freedom Clinic, along with support from other hospital and health system members, successfully advocated for the codes. Working together, the focus is to educate hospital staff through a new web page featuring dedicated resources. MHA continues to provide resources through the S.A.F.E.R. Initiative, which offers guidance and resources to foster collaboration and develop safer care environments and resilient communities.

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Did You Miss An Issue Of MHA Today?

August 6, 2018
HIDI HealthStats — How Effective Are Medicaid MCOs At Managing Care In Missouri?

August 7, 2018
CMS Releases Final FY 2019 Payment And Policy Updates For IPPS And LTCH
MHA Releases CAH FFY2019 VBP Reports
June MUR Available On HIDI Analytic Advantage®
TJC Announces Pioneers In Quality Webinar

August 8, 2018
HIDI Releases First Quarter 2018 VBP Payments Model
CMS Updates eCQM Value Sets For 2019 Reporting
TJC Releases Specifications Manual Version 2018B

August 9, 2018
MHD Schedules Webinar For Clinics Wishing To Join Primary Care Health Home Program
STR-TA Offers Webinar On Primary Care Providers Implementing OUD Treatment
Mercy And SSM Announce Leadership Changes

Consider This ...

As many as 13 million people in the U.S. have latent Tuberculosis infection. Without treatment, they are at risk for developing TB disease in the future.

Source: Centers for Disease Control and Prevention