New Report Looks at Safety Net Plan Efforts to Promote Program Integrity in Medicaid
A new ACAP report examines ways in which Safety Net Health Plans work to promote program integrity in Medicaid. The report, which was written with support from Verisk Health
, an ACAP Preferred Vendor, highlights strategies employed by plans to prevent, detect and resolve fraudulent or wasteful activities.
The profiled activities include data analysis and claims review to identify aberrant claims patterns; the targeted use of Explanation of Benefit documents to alert members to help assure that billed services were actually delivered; partnership with regulators, law enforcement agencies and other health plans; employee training; and efforts to reduce avoidable adverse events such as hospital-acquired infections.
Press release > | Read the report >
Outdated Privacy Regulations Impede Care Coordination for People with Substance Use Disorder
A new ACAP report examines how Federal regulations interact with health plan efforts to coordinate care for their members with substance use disorder, or SUD. Among the Federal regulations relevant to health plans seeking to deliver coordinated care to their members are those found in Title 42, Part 2 of the Code of Federal Regulations—42 CFR Part 2, or “Part 2”. These regulations are intended to safeguard the confidentiality of patient records concerning alcohol and substance abuse treatment records.
The report finds that owing in part to these regulations, SUD treatment programs operate in silos; the integration of SUD services with mental and physical health care is impeded owing to the restrictions on the disclosure of SUD information, which interfere with care coordination between a provider and a health plan. In contrast, the patient privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) allow information sharing for the purposes of care coordination while maintaining strong privacy safeguards.
Read the report >
Related: Strategies to Reduce Prescription Drug Abuse >
Community Catalyst, ACAP Issue Findings on Survey of Plans Participating in Financial Alignment Demonstrations
A new report jointly issued by ACAP and Community Catalyst examines the results of a survey of fifteen ACAP plans participating in demonstration programs for dual eligibles underway across the country. The survey results, which highlighted plan innovations and challenges in the demonstrations, led the organizations to issue a set of fifteen policy and operational changes that could lead to concrete improvements in the demonstration.
“This report offers policymakers and health plan leaders insights into the challenges of system change,” said Robert Restuccia, executive director of Community Catalyst, “and also concrete strategies and recommendations on how to improve care in the areas that are of top importance to enrollees.”
Read the report and recommendations > | Press release >
ACAP Praises Proposed Changes to Risk Adjustment for Dual Eligibles
ACAP submitted a comment letter to CMS that details the support of Safety Net Health Plans for proposed changes to the risk adjustment system for health plans serving people who are dually eligible for Medicare and Medicaid. In an October 28 memo, CMS came to the conclusion that the Medicare Advantage (MA) risk-adjustment system under-predicts the costs of full-benefit dual eligibles, or people who qualify for full Medicaid benefits due to their low incomes and their health status.
Press Release | Full Letter
Related: ACAP Applauds Steps to Consider Full-Benefit, Partial Benefit Duals Separately
Related: Fact Sheet on Progress in Duals Demonstration Programs
Working Paper Examines Levels of "Churn" in Medicaid, Finding Little Improvement Over a Six-Year Period
A new working paper developed by researchers at George Washington University finds that the average person enrolled in Medicaid receives benefits, on average, for just 9.7 months of the year. This discontinuity in care owes itself largely to “churn,” where beneficiaries are disenrolled and reenrolled in the program owing to paperwork issues or small and often temporary changes in income, despite their underlying eligibility remaining unchanged. This cycle of enrollment and disenrollment leads to poorer health, results in higher-cost episodes of care, and frustrates the efforts of providers and others to deliver top-quality health care.
Press Release | Full Report | Coverageyoucancounton.org
Report Shows How Medicaid Programs Realize Savings Through Managed Care
ACAP issued a new report that examined projected savings of capitation in the Medicaid program. The report, authored by The Menges Group, pegged overall savings to Medicaid programs owing to capitation at $2.1 billion in 2011, and projected that these savings would increase to $6.4 billion in calendar year 2016. Much of these savings could be attributed to an increasing prevalence of contracting with Medicaid managed care organizations among states in the intervening years, as well as an overall increase in the number of lives covered by Medicaid owing to its expansion under the provisions of the Affordable Care Act.
Full Report | Press Release | Infographic