The 'Edge Report Blog

Key Takeaways from AHIP’s National Conferences on Medicare, Medicaid and Duals

November 01, 2016

Government programs are the fastest growing segment of the healthcare market.  According to CMS, Medicare has 57 million members, up 10% since 2013, including 38 million members in Original Medicare and 19 million members in Medicare Advantage.  Medicaid has 73 million members, up 27% since 2013 due to Medicaid expansion.

Last week health plan executives, industry experts, officials from CMS and of course vendors gathered in Washington, D.C. for AHIP’s National Conferences on Medicare, Medicaid and Duals.  There were many compelling stories and presentations, and here are a few key takeaways from the preeminent conference on government sponsored health plan programs:

Access to Medical Services for High Risk Populations

Pat Wang, the CEO of Healthfirst, a health plan that serves disadvantaged populations, spoke about cultural barriers to adherence, explaining that language as well as cultural customs for obtaining and delivering treatment, can be enablers or disablers.  These factors must be accounted for to properly serve both Medicare and Medicaid members.  “Feet on the street” and the personal touch, along with the proper training and skills, can boost engagement levels and serve as catalysts for establishing trust between the health plan and its members.  John McCarthy, the Director of the Ohio Department of Medicaid, echoed this thought two days later, stressing that cultural competency and taking responsibility for the person, with education and resources, can make all the difference.

Collaboration Between Payer and Provider

It’s a long standing goal, and an elusive reality for the industry.  Many speakers addressed the challenge to give providers capabilities to manage risk with relevant insights at the point of care. It was acknowledged that true integration of information from healthcare’s many sources has yet to occur, and delivering actionable information to physicians within their established workflow remains a significant challenge, with a great payoff once it is effectively solved. Another key point, voiced by John Baackes, CEO of L.A. Care Health Plan was the importance of recognizing who is really leading the management of care for a specific member.  With multiple stakeholders involved in a coordinated care plan, one must be the lead, with the rest filling out the care team. It’s not always in the best interest of the patient for the health plan to be in that position – each situation has specific needs.

CMS is Leading the Way

Andy Slavitt, Acting Administrator of CMS, gave the final keynote of the Medicare portion of the conference, and spoke enthusiastically of the success of the Medicare Advantage program as well as Medicaid expansion.  Slavitt talked about “health equity” as a societal goal, and sees Medicare Advantage as a possible path to an equitable healthcare experience for the membership of government-sponsored health plans.  He also stressed that continued innovation cannot be sacrificed at the expense of keeping health insurance affordable.  Slavitt urged the audience to continue innovating while finding ways to deliver quality healthcare at affordable prices and acknowledged that there are no silver bullets.  The Center for Medicare and Medicaid Innovation was cited by several speakers, including Andrew Davis, VP & GM of the Medicare segment at Medica, as instrumental in partnering with health plans to push new models for value-based reimbursement.  MACRA was identified as a significant push forward in transforming the industry beyond Fee for Service.  Slavitt stressed that it will be important going forward to use one set of quality measures, to help provider practices minimize their administrative burden.  He also stated that the role of technology is to make things easier, and admitted that EHR’s have yet to do so in the eyes of both providers and patients.  Finally, Acting Administrator Slavitt told the audience that when his successor takes over CMS, his advice would be to move more decision-making into the regions, with less monolithic and centralized actions.

Community Resources Play a Critical Role

In the first general session of the Medicaid conference, Victoria Wachino, CMS Deputy Administrator and Director, Center for Medicaid & CHIP Services, stated that 50% of care under Medicaid is delivered either in a home setting or as community-based care.  This means that only half of care in the Medicaid program is delivered in an institution.  The importance of community-based resources, such as adult day care, transportation systems and even pet food banks for those who cannot afford to feed their pets and themselves, have taken on a new criticality.  Many more Medicaid members are capable of functioning on their own, but also require assistance to successfully navigate their everyday lives.  Partnerships between state Medicaid agencies and local community agencies can bring benefits to populations such as elders and special needs that were unavailable in the past.  With local health coaches and patient advocates, members can be encouraged to live healthier lives, which in turn reduces costs.  A case study presented by Virginia Premier health plan in conjunction with the Peninsula Agency on Aging and Bay Aging from Virginia was one such example.  The local agencies, through contracts with Virginia Medicaid, are combining the resources of area hospitals, health systems, as well as the agencies and health plans, to provide a wide spectrum of care to those most in need.  The results have been compelling and include healthier members along with noticeable cost savings.  Hospital readmission rates in the region decreased from 25% to 13%.  In another example, Jonas Thom, the VP of Behavioral Health of CareSource stated that his plan wants to use the local behavioral health agency’s care management resources and sees no reason to duplicate it.  Working in close partnership, CareSource is providing Greater Cincinnati Behavioral Health Services with the critical data they need, and the agency, with its deep roots in the community, develops the high touch relationship with the members.  The new reality is that breaking down the traditional barriers across the healthcare ecosystem and working towards shared goals will yield new outcomes and success stories.