Michael Ceballos’ Post

On March 31, 2023, Centers for Medicare & Medicaid Services (CMS) announced the gradual transition to V28 of the CMS-HCC model. Phased in over time, the plan is to switch completely to the updated model by 2025. This change has widespread implications and all health plans should already be thinking about this transition. The new V28 Model: The V28 model is more than just another update; it's a fundamental change in the way health plans manage risk and assess patient populations. Estimates suggest this model will decrease Medicare Advantage risk scores anywhere between 3-8%. Such changes have far-reaching implications for health plans, impacting revenue, care planning, and overall strategic direction. Transitioning Timeline: The V28 CMS-HCC risk adjustment model is here, and understanding the transition timeline is crucial. In 2023, the V24 model carries significant weight with 67%, while the new V28 model holds a 33% share. This balance undergoes a substantial shift in 2024, with 67% of the weight now assigned to the V28 model and only 33% to the V24 model. By 2025, the transition is complete, with the V28 model taking center stage at 100%.

Changes to V28 HCC model

Primary care is the backbone of a strong health care system. As such, state Medicaid programs are testing policies to strengthen primary care, including new payment approaches. A new primer from Center for Health Care Strategies explores six key design choices that state #Medicaid programs need to make when developing or refining a population-based payment (PBP) model and the implications of these choices, including impacts on health equity for patients and providers. PBP models seek to move away from volume-based, fee-for-service payments and toward predictable “budgets” that support population health management, flexible service delivery, and financial stability for participating providers and the states implementing these models.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center today provided an update on the progress of its #healthequity initiative, which was launched in 2022 following the Innovation Center's 2021 strategy refresh. For 2024, the Innovation Center is focused on three key areas for advancing its health equity goals: 1️⃣ Safety-net provider participation in models to improve care for more beneficiaries - The ACO REACH Model doubled safety net participation in 2023 and increased by another 25 percent in 2024. - New models have an explicit focus on including FQHCs (e.g., Making Care Primary, States AHEAD, ACO PC Flex). - NAACOS in 2023 offered recommendations to CMS on opportunities to reduce barriers for safety net providers to succeed in #valuebasedcare. Read more here: https://lnkd.in/e7xVhJSh 2️⃣ Data collection and tools that support #wholepersoncare - CMS is working to collect more sociodemographic and health related social needs (HRSNs) data from model participants. - CMS is requiring health equity plans as a framework to help model participants identify the needs of the communities they serve and reduce disparities. 3️⃣ Payment innovations to narrow disparities - CMS is currently testing two approaches to payment adjustments to advance equity: income status or eligibility for means-tested programs, and the economic and social deprivation in a locality. Read more: https://lnkd.in/eXrpC5Je

Centers for Medicare & Medicaid Services announces transformative model to give states incentives and flexibilities to redesign health care delivery, improve equitable access to care Read about the new States Advancing All-Payer Health Equity Approached and Development (AHEAD) model here: https://lnkd.in/eSSnJUui #AHEADmodel #valuebasedcare #vbc #healthcareinnovation

The Centers for Medicare & Medicaid Services (CMS) has approved an amendment to New York's Medicaid program, advancing health equity and enhancing access to primary and behavioral health care. This approval allows New York to make substantial investments in Medicaid initiatives, including sustainable base rates for safety net hospitals, housing and nutritional support services, coordinated treatment for substance use disorders and long-term investments in the healthcare workforce. This emphasizes the importance of collaborative state initiatives to address health disparities and promote a more integrated and person-centered health and social care system. Learn more at https://go.cms.gov/3Isbyb0. #CaseManagementSoftware #EHR #HealthEquity #CommunityCareLink #ElectronicHealthRecord #ConnectingCommunities

The Centers for Medicare & Medicaid Services #AHEAD Model represents the next iteration of the CMS Innovation Center’s multi-payer total cost of care models. States participating in AHEAD will be accountable for #quality and #populationhealth outcomes, while reducing all-payer avoidable health care spending to spur statewide and regional health care transformation.  This model will be a voluntary Model with #CMS partnering with states to redesign statewide and regionwide health care delivery to improve:  ·        quality and efficacy of care delivery  ·        reducing health disparities  ·        improving health outcomes  AHEAD also includes specific payment models for participating hospitals and primary care practices as a tool to achieve Model goals.   CMS will issue awards to up to eight states. Each state selected to participate in the AHEAD Model will have an opportunity to receive up to $12 million from CMS to support state implementation. The release of specific application requirements will be released in late fall of 2023.    ▶ Pre-Implementation Period: Beginning First cohort Summer 2024  ▶ Model Performance Period: January 2026 or January 2027  ▶ Model Conclusion: December 2034    CMS States the AHEAD model will look to:  1️⃣ Focus resources and investment on primary care services and ability to improve care management and better address chronic disease, behavioral health, and other conditions.  2️⃣ Provide hospitals with a prospective payment stream.  3️⃣ Address health care disparities through stronger coordination across health care providers, payers, and community organizations  4️⃣ Address the needs of individuals with Medicare and/or Medicaid by increased screening and referrals to community.    Participating state(s) will have a Medicare total cost of care growth target in the AHEAD Model determined by CMS in the pre-implementation period. The all-payer cost growth targets, which will be set by states, will encourage states to align payer efforts to slow the growth of health care costs while driving transformative change. States will also have a Medicare and an all-payer primary care investment target to enhance primary care delivery. 

Step 1 - Force Medicaid to pay at least the cost of delivering care - this is critically important for Community Health Centers and other providers concentrated in Medicaid patients. Step 2 - Simplify the work environments of delivery team members. Reduce the number of measures and multitasking added over the last 20 years Step 3 - Stack funding toward counties chronically lowest in health care workforce. This is usually about worst paying public and private plans that must be held accountable plus special funding for the practices that have half enough primary care, mental health, and basic workforce. Step 4 - Force states to stop shaping and tolerating the worst paying worst quality health plans Once again too may efforts are wasted on bandwagon terms such as population based or social determinants. MOST AMERICANs are SUFFERING long term chronic basic health access deficits that are shaped by the health care design. Fix the design. Do not punish providers for the sin of caring for populations inherently lower in outcomes and drivers of outcomes. Please stop this performance-based aberration. These practices are already paid less and penalized more - causing more harm to populations already harmed.

States that are considering applying to the latest total cost-of-care model from the Centers for Medicare & Medicaid Services (CMS) — the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model — can expect a competitive process. CMS will select up to eight states to participate. As states assess their interest and readiness to pursue the model, they must consider important governance considerations and balance the requirements with their broader transformation goals. Get insights on governance requirements, application details, and additional strategic considerations in the first post in our new blog series on key components of the AHEAD Model: https://loom.ly/35oxvDs

Health equity is a concept that emphasizes providing equal access to healthcare facilities to everyone regardless of their background or financial status. It aims to remove the disparities that exist in our healthcare system and make it fair for everyone. The idea is to ensure that everyone has access to quality medical services, and no one is left behind due to their race, ethnicity, or financial situation. Health equity is a critical aspect of public health, and we must work towards transforming our healthcare system into one that is just, accessible, and comprehensive for all. We need to ensure that every individual has access to the medical care they need, and we must address the systemic inequalities preventing this. #healthequity #publichealth #publicpolicy #healthcare