| News & Insight
Medicaid & Medicare Prepare for the End of the Public Health Emergency
In November 2022, United States Senators Cassidy, Carper, Scott, Warner, Cornyn, and Menendez issued a request for information (RFI) regarding approaches for improving coverage for individuals who are dually eligible for Medicare and Medicaid. Dual eligible beneficiaries are more likely to have complex health needs that are difficult and often expensive to treat. Too often, they experience a lack of integration and coordination that often results in confusing encounters with the health care system and negative health outcomes.
Senators Request Public Input to Inform Decision Making on Programs Serving Dual Eligible Enrollees
In November 2022, United States Senators Cassidy, Carper, Scott, Warner, Cornyn, and Menendez issued a request for information (RFI) regarding approaches for improving coverage for individuals who are dually eligible for Medicare and Medicaid. Dual eligible beneficiaries are more likely to have complex health needs that are difficult and often expensive to treat. Too often, they experience a lack of integration and coordination that often results in confusing encounters with the health care system and negative health outcomes.
Expert RFI Responses with Potential to Improve Medicare
Over the past few months, Congress and the Department of Health and Human Services (HHS) have issued a wave of new health care-related requests for information (RFIs). These RFIs come at a time when the country is shifting to address deficiencies in the health care system COVID helped to expose.
Webinar: Making Sense of Payment Mechanisms in ACO REACH
On Tuesday, June 28, 2022, Aurrera Health Group and Milliman experts gave an in-depth presentation to applicants of the CMS ACO REACH model and/or current Direct Contracting Entities.
Leveraging Robust Evaluation Principles to Make Medicaid Better
A core element of all Medicaid Section 1115 “research and demonstration” waivers is an evaluation of the demonstration program and its efficacy in meeting the demonstration’s goals. Historically, however, Section 1115 waiver evaluations have been an afterthought for states and CMS, limiting their ability to inform future Medicaid policy and financing approaches.
Supporting Medicaid Providers in CalAIM Implementation
Last year, Aurrera Health Group teamed up with the California Department of Health Care Services to provide early education and targeted technical assistance for providers on implementing Enhanced Care Management and Community Support services, two key parts of the CalAIM initiative. This experience revealed several promising practices for other states pursuing whole-person approaches to health care delivery.
REPORT: Risky Business: California Health Centers Weakened by the COVID-19 Pandemic Prepare for the Future
California’s Federally Qualified Health Centers experienced many financial challenges as a result of the COVID-19 pandemic.
REPORT: Whole Person Care Promising Practices: A Roadmap for Enhanced Care Management and In Lieu of Services
The enhanced care management benefit (ECM) and in lieu of services (ILOS) proposed under the California Advancing and Innovating Medi-Cal (CalAIM) proposal build upon the successes of California’s 25 Whole Person Care (WPC) pilots.
REPORT: How Medi-Cal Expanded Substance Use Treatment and Access to Care
Launched in 2015, the Drug Medi-Cal Organized Delivery System (DMC-ODS) is nation’s first Medicaid Section 1115 waiver to expand access to substance use disorder (SUD) treatment services.
California’s Public Hospitals are Improving Quality and Health Outcomes through PRIME
By Trish Violett, Junior Policy Consultant and Megan Thomas, Director, Quality Initiatives
Over the past four years, the 52 hospitals and health systems participating in the California Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program have been working to improve care delivery and maximize health care value through a “pay-for-performance” model. The PRIME hospitals are using evidence-based quality improvement methods to achieve designated goals and outcomes on select clinical projects and associated performance metrics.
Strategies for Coordinating Behavioral Health Care for California Dual Eligibles
By Lilly Clements, Junior Policy Consultant and Megan Thomas, Associate Director
Since 2014, the Cal MediConnect (CMC) program has coordinated care for some of the most vulnerable Californians. CMC was developed by the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) to better serve dual eligible beneficiaries – those enrolled in both Medicare and Medi-Cal (Medicaid in California).
A primary focus of CMC is to better coordinate behavioral health care service delivery for members. This week, DHCS released a report entitled “Improving Behavioral Health Integration and Coordination for Cal MediConnect (CMC) Members,” which details the complexities and nuances of CMC plans’ efforts to integrate behavioral health into the care delivery system for dual eligible beneficiaries.
