Category: Advocacy

State Reveals ICOs in Dual Eligible Care Demonstration

More than a month passed their anticipated announcement date of September 21st, the state’s Executive Office of Health and Human Services (EOHHS) named the Integrated Care Organizations, or ICO’s, that will be managing and directing both payment and care for the demonstration to integrate services for dual eligibles.

The six organizations are Blue Cross and Blue Shield of Massachusetts HMO Blue Inc. (BCBSMA), Boston Medical Center HealthNet Plan (BMCHP), Commonwealth Care Alliance (CCA), Fallon Total Care, LLC (FTC), Neighborhood Health Plan (NHP), Network Health, LLC. Only Network Health was picked to serve every county in the state and will be the only ICO in Nantucket and Martha’s Vineyard.

Aside from Network Health, all other ICO’s are listed in as few as three counties and as many as eleven.

These organizations were selected for full (F) or partial (P) Massachusetts counties as follows:

BCBSMA BMCHP CCA FTC NHP Network Health
Barnstable F F F F
Berkshire F F
Bristol F F F F
Dukes F
Essex F F F F F
Franklin F F F F
Hampden F F F F F
Hampshire F F F F F
Middlesex F F F F F F
Nantucket F
Norfolk F F F F F
Plymouth F F P F F
Suffolk F F F F F F
Worcester F F F F

These organizations will now be engaged in a “readiness review” over the next two months. As part of the review, EOHHS and CMS will require that the organizations demonstrate full readiness and meet operational requirements.  An ICO will not be able to accept enrollments without successfully completing the joint Readiness Review, negotiating and executing a three-way contract, and receiving any necessary state and federal approvals.

Return to www.thinkhomecare.org.

DHCFP Has Changed to CHIA

The state’s Division of Health Care Finance & Policy (DHCFP) is now an independent state agency called the Center for Health Information and Analysis (CHIA) thanks to the new Health Care Payment Reform Law (Chapter 224 of the Acts of 2012).

The new state agency will have most of the responsibilities pertaining to health care data collection, dissemination and analysis, but according to their website, “CHIA will also take on new roles in support of its mission to examine health care cost and quality information and provide objective data and analysis to assist in the formulation of health care policy.”

CHIA will continue to manage the All-Payer Claims Database and run the annual Cost Trends hearings, but will be collecting and analyzing data in particular that deals with how the new health care payment law is affecting cost trends. Last year, the Home Care Alliance sat on an expert panel to help provide a broader picture of cost trends in Massachusetts and the potential impact of Accountable Care Organizations.

HCA will continue to report on the implementation of Chapter 224 as information becomes available.

Return to www.thinkhomecare.org.

 

November is National Home Care Month – Help Us Celebrate!

Join the Home Care Alliance in celebrating National Home Care Month throughout November by visiting our new webpage www.thinkhomecare.org/homecaremonth.

On that site, the Alliance has posted materials to help home care agencies and advocates celebrate and raise awareness. There are templates for a press release, op-ed’s, and letters to the editor that can be sent to local media as well as downloadable posters that can be posted in your office and community.

Be sure to follow us on Facebook and Twitter where the Alliance will be posting a “Home Care Fact of the Day” each day in November, along with other important news and updates. We have 142 “Likes” and are aiming to get to 150 and beyond!

HCA has plenty of educational and training events in November so please be sure to check our busy calendar of events this month.

Finally, our radio campaign in partnership with WGBH is still ongoing so stay tuned to 89.7 FM or Classical New England (99.5 FM) to hear great sponsorships from HCA members.

For more info on how to celebrate and raise awareness, or if you would like assistance with the press materials, please contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

New Info Coming Soon on Money Follows the Person Initiative

The Massachusetts version of the federal Money Follows the Person initiative, held a stakeholders meeting at the Worcester Public Library with a review of activity and a “heads-up” that an RFR will be coming out next month for the five coordinating entities that will manage money and services.

Dubbed Regional Coordinating Offices, or RCO’s, these newly formed entities will provide access to housing search for MFP transitional entities along with transition assistance itself as participant move from a facility to the community. RCO’s will also provide orientation and mobility training, assistive technology, and case management. The five RCO’s will chosen by January 2013 based on an RFR due out by this November.

In February 2011, CMS awarded a five-year Money Follows the Person Demonstration grant to Massachusetts. The funding will, according to the state’s office of Health and Human Services, will help transition more than 2,200 individuals out of nursing facilities, long-term care facilities, chronic care hospitals, and intermediate care facilities into community-based care.

HCA will continue to provide updates on this program, which are also available at on mass.gov here.

Return to www.thinkhomecare.org.

State Holds Health Payment Reform Info Session

Health care advocates and stakeholders packed and overflowed a large conference room meant to host an information session on the implementation progress of the new health care payment reform law.

Governor Patrick walked in mid-session and summed up the intent of the meeting where every state agency and department mentioned in the law was present to speak on their respective piece. The Governor explained that it took a lot of work to pass what he termed ‘a good bill’, but added that ‘now the real work begins.’ He said that it will take work on the part of government, providers, and stakeholders to ensure that the law is implemented effectively and the way in which it was intended.

To that end, Health and Human Services Secretary JudyAnn Bigby reported that the 11-member board of the Health Policy Commission, the main group charged with developing the policy necessary to implement the law, will be convened by November 5. The work of putting together other task forces and commissions, including those where the Home Care Alliance has the authority to name a representative, has already begun.

One of HCA’s victories in the legislation was the ability to name members on the Behavioral Health Task Force and the Commission to Review Public Payer Reimbursement Rates.

Other state agencies and their responsibilities are being reconfigured, including the Division of Health Care Financing becoming the Center for Health Information and Analysis. That group will be an independent state agency and so-called “pricing activities” relative to rate setting will move under the Executive Office of Health and Human Services.

The Alliance will provide updates as they become available and the state has an implementation website with more information at http://www.mass.gov/governor/agenda/healthcare/cost-containment/.

Return to www.thinkhomecare.org.

Alliance Members Talk Care Transitions, CON With State Survey Head

Madeleine Biondolillo, MD, the Director of Health Care Safety and Quality at MA Department of Public Health  informed home health executives this week that efforts by the state to support better care transitions may eventually become more deliberate – possibly by adding care transitions “compliance” to the state survey process.  In a discussing her Division’s plans with the executives,  Dr.  Biondolillo indicated a strong preference for “leveraging her Department’s regulatory clout”  to drive improvement in the patient care experience.   She shared a draft survey tool that DPH developed with the nursing home industry and  that surveyors could eventually incorporate into the state survey process. The tool has been tested in four long term care facilities to date and has been shared with CMS as a possible national model for survey reform. The form incorporates resident/patient interviews using the 3-Item care Transition Measure (CTM-3), which Biondolillo suggested has the endorsement of the National Quality Forum for use in evaluating transition quality.

In response to questions and comments from some of the home health executives at the meeting, Dr Biondolillo:

–          reflected on the possibility of introducing a determination of need (DON) process  in Massachusetts for home health saying the DON rules may be reopened for changes in the coming year.   The compelling argument for home care or hospice would, she said, be quality of care based, not economic.

–          indicated a willingness to assist the Home Care Alliance  in getting physicians and hospitals to understand the complex Face to Face rule

–          expressed from her own personal experience as a physician support for home health efforts to change  Medicare practice to allow Nurse Practitioners to sign plans of care

–          agreed with sentiments expressed by at least one home health executive that there may be more that can be done to educate physicians that different patients may benefit from different post acute paths (i.e, directly  with support home) rather than following a standard for all patients path through a rehab hospital and/or nursing home

New Website Created on State Health Care Payment Law Implementation

The state has announced a new web page on Mass.gov that will serve as a clearinghouse for information as the state implements the new health care cost containment law signed by Governor Patrick in August.

The site will host important announcements about the new law as well as information on Grants & Demonstrations,Stakeholder Meetings andBoards, Commissions & Task Forces. 

Thanks to the advocacy efforts of the Home Care Alliance, the association has been given the authority to name members on the “Task Force Related to Behavioral, Substance Use Disorder, and Mental Health Treatment”  as Governor Deval Patrick, joined by Secretary Jay Gonzalez, Secretary JudyAnn Bigby, Rep. Steven Walsh, Rep. Ronald Mariano, Attorney General Martha Coakley, Speaker of the House Robert DeLeo, signs the health care cost containment bill in Nurses' Hall. well as the “Commission to Review Public Payer Reimbursement Rates.”

The website also announces meetings to inform stakeholders of progress and potential opportunities related to the new law so those interested are encouraged to check the site regularly and stay tuned to our blog for other important updates.

Return to www.thinkhomecare.org.

HCA Starts Congressional Letter on Home Care Moratorium

Thanks to the advocacy efforts of the Home Care Alliance and the cooperation of legislative home care champions, Congressmen Jim McGovern (D-MA) and Walter Jones (R-NC) are circulating a letter to be sent to federal Health and Human Services Secretary Kathleen Sebelius urging her agency to utilize the authority given in the Affordable Care Act to establish a temporary and targeted moratorium on new home health providers to control fraud and abuse in troubled areas.

Alliance staff drafted the letter, which is now a bipartisan effort that is seeking support from Congressional representatives from across the country. HCA has sent direct letters to Secretary Sebelius in the past and has supported drives by national associations towards getting a temporary and targeted moratorium established. The fact that the entire industry has been punished for the actions of a few agencies in a few areas of the US has driven the repeated attempts at lobbying HHS. This moratorium action certainly would not halt fraudulent and abusive practices, but it does help to contain the problem, especially in areas that have seen dramatic growth in the number of certified home health agencies.

The Alliance strongly encourages its members and supporters to contact their representative and urge them to sign on. Let your federal representative offices know that they should contact Congressman McGovern’s office to sign on.

Return to www.thinkhomecare.org.

The Alliance’s Colleen Bayard on the the Affordable Care Act

Colleen Bayard, the Alliance’s director of regulatory & clinical and regulatory affairs, spoke to WWLP News 22 this week about the impact of the Affordable Care Act on seniors in Massachusetts.

BOSTON (WWLP) – Government health officials say that President Obama’s national health care reform law is saving Massachusetts seniors big bucks.

Federal officials say the 2010 law has helped save Massachusetts seniors more than $76 million on medication bills this year.

The U.S. Department of Health and Human Servicessays in the first eight months of this year, the Affordable Care Act has saved seniors in Medicare’s “donut hole” about $610 dollars. Previously, when seniors were in this “donut hole” they would go from making copayments for their drugs to paying 100 percent of the cost.

The law gives them significant discounts.

“There’s actually extra funding for medications for seniors,” said Colleen Bayard, the Clinical Affairs Director for the Home Care Alliance of Massachusetts.

“They may not have enough money for their medications and it becomes unaffordable, but I think they’re trying to, they made changes with the medication in Medicare D to help with that.”

The average savings for a Massachusetts resident with Medicare will be $5,000. People with high prescriptions costs will save more than $18,000 from 2010 to 2022.

New Reports on Hospital Readmissions from STAAR and DHCFP

The Massachusetts State Action on Avoidable Readmission (STAAR) project has published a new report on the Patient Care Link website. The report – Reducing Readmissions: Highlights from the Massachusetts STAAR Cross Continuum Teams  – includes improvement stories from 22 of the 50 cross continuum teams working on reducing readmission.

Available on the Preventing Avoidable Readmissions page of the MA Coalition to Prevent Medical Errors website is a digest of customizable tools that eleven of the teams have made available free of charge. The STAAR work and these reports were funded by a grant from the Commonwealth Fund.

Also available from the state’s Division of Healthcare Finance & Policy (DHCFP) is a pair of new health care cost trend reports that conclude preventable hospitalizations have slowed, although preventable emergency department use has slightly risen.

The first report states that preventable hospitalizations are not driving cost growth, but remains a significant percentage of overall health care expenditures. Some of the more notable findings indicate that nearly half of preventable hospital admissions are for people aged 75 and older and 64 percent are for those over 65 years of age.

The report suggests something of no surprise to home care agencies, which is that managing chronic illnesses between non-acute health care settings is the best approach to combating the issue. However, the report further states the fee-for-service pay structure remains a barrier to that method working efficiently. Demographic influences aside from age were also noted as those lower income and some minority groups were more likely to receive costly and inefficient care that led to a higher rate of preventable hospitalizations among those groups.

As for the DHCFP report on hospital emergency department efficiency, the number of preventable ED visits rose 6.3 percent from 2006 to 2010 to a total of more than 1.17 million. Preventable or avoidable visits, the report continues, accounted for more than 45 percent of total ED visit costs.

To see both DHCFP reports, visit their  Cost Trends page.

Return to www.thinkhomecare.org.