In The News

NIH task force formed to develop first nutrition strategic plan

Strategic plan will complement and enhance ongoing research efforts across NIH on diseases and conditions affected by nutrition.

Click here to read the full article

CMS NEWS: Medicare Advantage Value-Based Insurance Design Model

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation is announcing refinements to the design of the second year of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model.  The MA-VBID model is an opportunity for Medicare Advantage plans (MA plans), including Medicare Advantage plans offering Part D benefits (MA-PD plans), to offer clinically nuanced benefit packages aimed at improving quality of care while also reducing costs.

In the second year of the model, beginning January 1, 2018, CMS will: open the model test to new applicants; conduct the model test in three new states - Alabama, Michigan, and Texas; add rheumatoid arthritis and dementia to the clinical categories for which participants may offer benefits; make adjustments to existing clinical categories; and change the minimum enrollment size for some MA and MA-PD plan participants.

Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees to use high-value clinical services – those that have the greatest potential to positively impact enrollee health.  VBID approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care while reducing its cost for Medicare Advantage enrollees with chronic diseases.  As part of the “better care, smarter spending, healthier people” approach to improving health care delivery, CMS will test VBID in Medicare Advantage and measure whether structuring patient cost sharing and other health plan design elements encourages enrollees to use health care services in a way that improved their health and reduces costs.

The MA-VBID model will begin January 1, 2017 and run for five years. CMS expects to release a Request for Applications for the second year of the model test in the fall of 2016, and will accept proposals from MA and MA-PD plans to offer VBID benefits in 2018.

In its first year, CMS will test the model in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.  Beginning January 1, 2018, CMS will also test the model in Alabama, Michigan, and Texas.  These states have been selected in order to be generally representative of the national Medicare Advantage market, including urban and rural areas, areas with both high and low average Medicare expenditures, areas with high and low prevalence of Low-Income Subsidies, and areas with varying levels of penetration of and competition within Medicare Advantage.  Test states have also been selected based on the availability of appropriate paired comparison areas for the purposes of evaluation.  Eligible MA plans in these states, upon CMS approval, may offer varied plan benefit designs for enrollees who fall into certain clinical categories identified and defined by CMS.  Benefit design changes made through this model may reduce cost sharing and/or offer additional services to targeted enrollees; however, targeted enrollees can never receive fewer benefits or be charged higher cost sharing than other MA enrollees in their plan as a result of the model.

Background

The existing Medicare Advantage “uniformity” requirement generally requires that an MA plan’s benefits and cost sharing be the same for all plan enrollees.  Because of this, clinically-nuanced VBID approaches have generally not been incorporated into MA or MA-PD plans.

The model will test the hypothesis that giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to targeted groups of enrollees with CMS-specified chronic conditions in order to encourage the use of services that are of highest value to them, will lead to higher-quality and more cost-efficient care.  The increase in high-quality, cost-efficient care is expected to improve beneficiary health, reduce utilization of avoidable high-cost care, and reduce overall costs for plans, beneficiaries, and the Medicare program.  The model is also intended to improve outcomes and reduce costs by encouraging targeted enrollees to obtain care from high-value providers and by providing new supplemental benefits specifically tailored to targeted enrollees’ clinical needs.

The MA-VBID model is authorized under Section 1115A of the Social Security Act (added by section 3021 of the Affordable Care Act) (42 U.S.C. § 1315a), which authorizes the Center for Medicare and Medicaid Innovation to test innovative health care payment and service delivery models that have the potential to reduce Medicare, Medicaid, and Children’s Health Insurance Program expenditures while preserving or enhancing the quality of beneficiaries’ care.  CMS will test this model in the Medicare program through a limited waiver of the Medicare Advantage and Part D uniformity requirements.

Description

The MA-VBID model supports improved health outcomes and health care cost savings or cost neutrality through the use of structured patient cost sharing and other health plan design elements that encourage enrollees to use high-value clinical services.  The MA-VBID model will provide flexibility for MA and MA-PD plans accepted into the model to develop clinically-nuanced benefit designs for enrollee populations that fall within certain clinical categories.

The conditions are:

  • Diabetes
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congestive Heart Failure (CHF)
  • Patient with Past Stroke
  • Hypertension
  • Coronary Artery Disease
  • Mood disorders
  • Rheumatoid Arthritis (starting in 2018)
  • Dementia (starting in 2018)

In addition to developing interventions targeted at all enrollees in one or more of the above categories, participating MA plans will have the flexibility to identify specific combinations of the listed chronic conditions for one or more “multiple co-morbidities” groups and establish tailored VBID interventions for each group.  Participating MA plans are required to provide VBID benefits to all VBID-eligible enrollees in the selected group.  Participating MA plans selecting the Mood Disorders group will also have additional flexibility to focus on specific conditions within that group.

For each of the selected enrollee groups, participating plans may select one or more plan design modifications from a menu of four general approaches. Within each approach, plans have flexibility on how (and to what extent) to implement that approach. Plans may vary their proposed interventions from one target population to another, and from one participating plan to another. CMS will also consider proposals for related variants of these interventions offered to targeted groups of enrollees, such as supplemental benefits conditional on participation in a disease management program.

The four approaches are:

1. Reduced Cost Sharing for High-Value Services

Plans can choose to reduce or eliminate cost sharing for items or services, including covered Part D drugs, that they have identified as high-value for a given target population. Participating plans have flexibility to choose which items or services are eligible for cost-sharing reductions; however, these services must be clearly identified and defined in advance, and cost-sharing reductions must be available to all enrollees within the target population.

Examples of interventions within this category include eliminating co-pays for eye exams for diabetics and eliminating co-pays for angiotensin converting enzyme inhibitors for enrollees who have previously experienced an acute myocardial infarction.

2. Reduced Cost Sharing for High-Value Providers

Plans can choose to reduce or eliminate cost sharing when providers that the plan has identified as high-value treat targeted enrollees.  Plans may identify high-value providers based on their quality and  not solely based on cost, across all Medicare provider types, including physicians/practices, hospitals, skilled-nursing facilities, home health agencies, ambulatory surgical centers, etc.

Examples of interventions within this category include reducing cost sharing for diabetics who see a physician who has historically achieved strong results in controlling patients’ HbA1c levels and eliminating cost sharing for heart disease patients who elect to receive non-emergency surgeries at high-performing cardiac centers.

3. Reduced Cost Sharing for Enrollees Participating in Disease Management or Related Programs

Participating plans can reduce cost sharing for an item or service, including covered Part D drugs, for enrollees who choose to participate in a plan-sponsored disease management or similar program. This could include an enhanced disease management program, offered by the plan as a supplemental benefit, or it could refer to specific activities that are offered or recommended as part of a plan’s basic care coordination activities.  Plans using this approach can condition enrollee eligibility for cost-sharing reductions on meeting certain participation milestones. For instance, a plan may require that enrollees meet with a case manager at regular intervals in order to qualify. However, plans cannot make cost-sharing reductions conditional on achieving any specific clinical goals (e.g., a plan cannot condition cost-sharing reductions on enrollees achieving certain thresholds in HbA1c levels or body-mass index).

Examples of interventions within this category include elimination of primary care co-pays for diabetes patients who meet regularly with a case manager and reduction of drug co-pays for patients with heart disease who regularly monitor and report their blood pressure.

4. Coverage of Additional Supplemental Benefits

Under this approach, participating plans can make coverage for specific supplemental benefits available only to targeted populations.  Such benefits may include any service currently permitted under existing Medicare Advantage rules for supplemental benefits.

Examples of interventions within this category include physician consultations via real-time interactive audio and video technologies for diabetics, or supplemental tobacco cessation assistance for enrollees with COPD.

Value-Based Insurance Design Participants for 2017

Medicare Advantage Organization

State

BCBS of Massachusetts

Massachusetts

Fallon Community Health Plan

Massachusetts

Tufts Associated Health Plan

Massachusetts

Geisinger Health Plan

Pennsylvania

Aetna

Pennsylvania

Independence Blue Cross

Pennsylvania

Highmark

Pennsylvania

UPMC Health Plan

Pennsylvania

Indiana University Health Plan

Indiana

Eligible Applicants and Application Process for 2018

The MA-VBID model test is open to all qualifying MA and MA-PD plans in the test states that submit acceptable programmatic proposals to CMS. Only certain MA and MA-PD plan types are eligible and certain restrictions apply to multi-state plans.

CMS will generally restrict the model test to plans with a minimum enrollment in the test states of 2,000 enrollees. However, beginning in 2018, a MA organization participating in the model test with at least one plan with enrollment over 2,000 enrollees may have additional Plan Benefit Packages (PBPs) participate with a minimum enrollee requirement of 500 enrollees; an additional plan benefit package using this lower enrollment requirement may be from that MA organization or other organizations with the same parent organization.  CMS may also grant an exception upon request.

Additionally, plans must meet minimum quality thresholds, including: being rated by CMS at three stars or higher, not consistently low-performing, not an outlier in the CMS past performance analysis, not under sanction, and able to pass a program integrity screening.

The plan must have been offered in at least three annual coordinated election (open enrollment) periods prior to the open enrollment period for the year for which the plan is applying to participate. There is no cap on the total number of participating plans.

CMS will accept applications for the second year of the MA-VBID model via a Request for Applications (RFA), to be released shortly.  Once released, application materials will be available at: http://innovation.cms.gov/initiatives/VBID.

More information

More information about the MA-VBID model test can be found in the model’s announcements and other documents, available at http://innovation.cms.gov/initiatives/VBID. The announcement includes instructions for providing CMS with feedback on this model test’s design.

For more information on the Center for Medicare and Medicaid Innovation’s division of Health Plan Innovation, please visit: http://innovation.cms.gov/initatives/HPI.

Government as a Platform for Progress: HHS’s Open Government Plan

By: Mary K. Wakefield, Ph.D., RN, HHS Acting Deputy Secretary

One of the first actions President Obama took after taking office was to direct federal agencies to find new ways to increase transparency, collaboration and public engagement. Since then, one of our top priorities at HHS has been to make our Department more open and accountable to the people we serve.

With the publication of our fourth HHS Open Government Plan, we’re building on our past performance in making government more transparent to the public and engaging in new ways of collaborating and partnering with our stakeholders. 

Read more: Government as a Platform for Progress: HHS’s Open Government Plan

Targeting cardiovascular disease risk factors may be important across a lifetime

NIH-funded study suggests efforts to prevent risk factors should extend to those older than 65.

Click here to read the full article

CMS Blog: The Medicare Current Beneficiary Survey: Celebrating Our 25th Anniversary and a Bright Future Ahead

http://blog.cms.gov/2016/09/29/the-medicare-current-beneficiary-survey-celebrating-our-25th-anniversary-and-a-bright-future-ahead

September 29, 2016

By Niall Brennan, Chief Data Officer, CMS

This year marks the 25th anniversary and the one millionth beneficiary interview for the Medicare Current Beneficiary Survey (MCBS), a survey that the Centers for Medicare & Medicaid Services (CMS) first fielded in 1991. This in-person survey of 15,000 Medicare beneficiaries collects valuable information about aspects of the Medicare program that cannot be analyzed based on CMS administrative data alone. In particular, the MCBS gathers information on self-reported health status, satisfaction with care, and functional limitations. The MCBS also collects information on beneficiaries that is key to understanding patient-centered care. Beneficiary’s out-of-pocket spending and source of payment for medical services received outside the Medicare program provides a window into the “invisible” and missed costs of health care. One unique aspect of the MCBS is that it includes beneficiaries who reside in institutional settings, such as a nursing home, as well as those in the community.

The MCBS is used across CMS to provide important insights that support internal program analyses. For example, over the past several years, the MCBS has become a key resource for evaluating the impact of CMS Innovation Center demonstration models as well as for approving Medicare Advantage and Prescription Drug Plan benefits.

The MCBS also serves as the foundation for thousands of health policy analyses across a diverse external user community. To date, we know of more than 1,000 peer-reviewed papers based on MCBS data in leading publications such as the New England Journal of Medicine, the Journal of the American Medical Association, Journal of Health Economics, and the Journal of the American Geriatrics Society.

Today, I want to acknowledge a number of important efforts CMS has undertaken to ensure the MCBS remains a valuable resource for the agency and external stakeholders. We have made the data more accessible, releasing the first ever MCBS public use file in May of this year. While MCBS data files have always been available for a relatively nominal fee, we heard that this fee was a barrier to entry for certain users such as students. We believe that increased access through this freely available public resource will expand the MCBS user community, and thus help cement its importance as a critical tool in the evaluation of systemic changes in the US health care delivery system.

We are also implementing changes to the MCBS questionnaire and survey design. Revising and improving the survey questions is underway. We have added new relevant content including an updated dental utilization module, a module on care coordination, and new questions on food security. Enhancing the sampling methodology to include newly enrolled beneficiaries in the first year of their Medicare enrollment, conducting an oversample of Hispanic beneficiaries, and, beginning in 2017, conducting an oversample of low-income beneficiaries increase our ability to conduct disparities research and improve our survey estimates.

We are also committed to a more rapid data release schedule, with improved user documentation and file structure. The 2015 MCBS files will be the first to have many of the improvements discussed above. We anticipate releasing the 2015 data file in the 2nd quarter of 2017, more than one year earlier than the previous file release schedule. The release of the 2015 data will also include improved chart books to accompany data releases and more intuitive naming conventions and file layouts with modern file formats for SAS, Stata, and R use. However, to accommodate these long overdue innovations, we had to make the difficult decision not to release 2014 data files.

As we celebrate our 25th anniversary of the MCBS, we are renewing our commitment to providing the most useful and relevant information about the Medicare program and, more importantly, the health and satisfaction of its beneficiaries.

We hope that you’ll visit us on our MCBS webpage at https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index.html where you can also subscribe for important updates and announcements.

New National Quality Strategy Priorities in Action

Two new Priorities in Action are featured on the National Quality Strategy's (NQS) Web site. The Priorities in Action series features some of our Nation's most promising and transformative quality improvement programs, and describes their alignment to the Strategy's six priorities.

  • Researchers at Indiana University designed the Geriatric Resources for Assessment and Care of Elders (GRACE) Team model as a solution to the health and health care challenges faced by low-income seniors with multiple chronic conditions. Their efforts promote effective communication and care coordination, one of the NQS six priorities, through the NQS levers of Innovation and Diffusion and Learning & Technical Assistance.
  • Better Health Partnership addresses the prevalence of heart disease in Ohio by developing and partnering with programs across the State that align with core principles of ongoing national health care delivery system reform efforts. The Partnership's efforts promote the prevention and treatment of the leading causes of morbidity and mortality, one of the six NQS priorities, through the NQS levers of Public Reporting and Innovation & Diffusion.

If your program aligns with the priorities, email NQStrategy@ahrq.hhs.gov with details.

Making Progress on Combating Antibiotic Resistance

September 19, 2016
By: Sylvia Mathews Burwell, HHS Secretary

This week, Secretary Burwell is traveling to New York City to address the United Nations General Assembly at a High-Level Meeting focused on antibiotic resistance. It’s a chance to share the progress we’ve made in combatting resistance, the direction we’re headed, and how important global cooperation is to global health – all points that the Secretary highlights in her blog post below.

– Kevin Griffis, Assistant Secretary for Public Affairs

***

Most of modern medicine is possible because antibiotics gave us the power to fight common infections. Unfortunately, we’ve seen this tool’s power gradually diminish over time. Every year, at least 2 million people become infected with antibiotic-resistant bacteria, and 23,000 die as a result.

To find a solution to this public health challenge, President Obama tasked HHS to work with our federal partners on a comprehensive, five-year National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB).

To put this plan into action, the CARB Task Force, which includes the Departments of Defense and Agriculture, has been working to implement the National Action Plan for over a year now. So I wanted to take this opportunity to share some of our progress.

Read more: Making Progress on Combating Antibiotic Resistance

CMS Blog: New data: 49 states plus DC reduce avoidable hospital readmissions

http://blog.cms.gov/2016/09/13/new-data-49-states-plus-dc-reduce-avoidable-hospital-readmissions

September 7, 2016

By Patrick Conway, M.D., principal deputy administrator and chief medical officer, CMS; and Tim Gronniger, deputy chief of staff, CMS

The unfortunate experience of having to return to the hospital after recently being treated—or watching the same thing happen to a friend or family member—is all too common. Potentially avoidable hospital readmissions that occur within 30 days of a patient’s initial discharge are estimated to account for more than $17 billion in Medicare expenditures annually.[1]  Not only are readmissions costly, but they are often a sign of poor quality care. Many readmissions can be avoided through improvements in care, such as making sure that patients leave the hospital with appropriate medications, instructions for follow-up care, and follow-up appointments scheduled to make sure their recovery stays on track.

To address the problem of avoidable readmissions, the Affordable Care Act created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions such as heart attacks, heart failure, and pneumonia. The Centers for Medicare & Medicaid Services has also undertaken other major quality improvement initiatives, such as the Partnership for Patients, which aim to make hospital care safer and improve the quality of care for individuals as they move from one health care setting to another.

The data show that these efforts are working. As described below, between 2010 and 2015, readmission rates fell by 8 percent nationally. Today, CMS is releasing new data showing how these improvements are helping Medicare patients across all 50 states and the District of Columbia. The data show that since 2010:

  • All states but one have seen Medicare 30-day readmission rates fall. [2]
  • In 43 states, readmission rates fell by more than 5 percent.
  • In 11 states, readmission rates fell by more than 10 percent.

Readmissions Data 

Across states, Medicare beneficiaries avoided almost 104,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels. That means Medicare beneficiaries collectively avoided 104,000 unnecessary return trips to the hospital. Cumulatively since 2010, the HHS Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions.

The Hospital Readmissions Reduction Program is just one part of the Administration’s broader strategy to reform the health care system by  paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality. Other initiatives include Accountable Care Organizations, as well as efforts by Quality Improvement Organizations and Hospital Engagement Networks, which fund quality improvement expert consultants to work with provider and hospital communities to improve care. The goal of all of these efforts is to spend our health care dollars more wisely to promote better care for Medicare beneficiaries and other Americans across the country.

State

2010

2015

% Change in Readmission Rates

Reduction in readmissionsin 2015 compared to 2010 

Hospital Admissions

Readmission Rate

Hospital Admissions

Readmission Rate

AK

9,809

14.50%

9,954

13.70%

-5.50%

-78

AL

154,856

17.20%

143,210

16.20%

-5.80%

-1,503

AR

103,056

17.70%

92,562

16.60%

-6.20%

-993

AZ

135,293

16.60%

128,061

14.80%

-10.80%

-2,270

CA

574,176

17.60%

547,558

16.60%

-5.70%

-5,580

CO

83,346

14.20%

81,822

12.90%

-9.20%

-1,099

CT

109,888

18.10%

96,492

16.70%

-7.70%

-1,306

DC

23,907

20.00%

23,194

18.50%

-7.50%

-346

DE

29,827

17.40%

32,257

15.60%

-10.30%

-575

FL

619,368

18.20%

588,187

17.70%

-2.70%

-3,161

GA

209,500

17.50%

191,485

16.20%

-7.40%

-2,453

HI

16,824

14.90%

15,799

12.90%

-13.40%

-315

IA

100,490

15.50%

91,256

14.50%

-6.50%

-910

ID

25,432

12.50%

28,139

12.20%

-2.40%

-78

IL

421,395

19.80%

335,610

17.40%

-12.10%

-8,108

IN

210,919

17.40%

186,241

16.10%

-7.50%

-2,474

KS

90,545

16.30%

87,224

14.70%

-9.80%

-1,361

KY

162,249

19.70%

132,511

17.90%

-9.10%

-2,384

LA

129,123

18.70%

112,328

16.90%

-9.60%

-2,013

MA

208,356

19.00%

197,649

17.90%

-5.80%

-2,213

MD

189,323

21.10%

170,510

18.90%

-10.40%

-3,789

ME

43,450

16.10%

38,571

15.50%

-3.70%

-232

MI

343,346

18.60%

280,152

18.00%

-3.20%

-1,767

MN

129,642

15.70%

130,725

14.60%

-7.00%

-1,435

MO

203,685

18.20%

174,677

16.90%

-7.10%

-2,311

MS

106,281

19.10%

96,252

17.60%

-7.90%

-1,469

MT

27,962

13.90%

27,518

13.10%

-5.80%

-231

NC

269,108

17.00%

235,283

15.90%

-6.50%

-2,472

ND

26,562

15.40%

26,650

14.40%

-6.50%

-267

NE

60,007

15.70%

56,791

14.40%

-8.30%

-735

NH

36,189

15.70%

39,871

15.30%

-2.50%

-152

NJ

281,282

20.30%

250,924

17.60%

-13.30%

-6,774

NM

36,209

15.20%

33,016

14.80%

-2.60%

-118

NV

51,787

18.00%

52,308

17.00%

-5.60%

-529

NY

491,897

19.90%

402,439

17.80%

-10.60%

-8,407

OH

325,091

18.80%

267,743

16.80%

-10.60%

-5,405

OK

119,346

17.40%

106,073

15.60%

-10.30%

-1,878

OR

58,182

14.30%

61,393

14.20%

-0.70%

-75

PA

369,418

18.10%

324,166

16.60%

-8.30%

-4,995

RI

24,142

19.00%

24,705

17.00%

-10.50%

-487

SC

130,950

16.50%

125,993

15.50%

-6.10%

-1,237

SD

31,269

14.90%

30,806

13.20%

-11.40%

-515

TN

207,875

18.40%

180,666

16.80%

-8.70%

-2,905

TX

571,147

17.10%

509,738

16.10%

-5.80%

-4,960

UT

33,534

12.20%

38,142

11.50%

-5.70%

-261

VA

207,241

17.50%

211,674

16.40%

-6.30%

-2,302

VT

15,439

15.30%

16,332

15.40%

0.70%

21

WA

130,798

15.30%

131,817

14.20%

-7.20%

-1,388

WI

137,336

15.60%

124,274

14.50%

-7.10%

-1,373

WV

70,144

19.90%

60,630

18.60%

-6.50%

-777

WY

13,277

15.10%

12,838

14.20%

-6.00%

-110


[1] Jencks, S. F., Williams, M. V. and Coleman, E. A. (2009). 'Rehospitalizations among patients in the Medicare fee-for-service program'. New England Journal of Medicine, 360 (14), 1418-1428.

[2] The readmission rate in Vermont was virtually unchanged, increasing slightly from 15.3% in 2010 to 15.4% in 2015. This change correlates to 21 additional readmissions compared to if the state’s rate had remained constant.

AHRQ Data Identify States That Rank Highest in Health Care Quality

Maine, Massachusetts, Wisconsin, New Hampshire and Minnesota were the nation's top-performing states for health care quality, according to AHRQ's updated State Snapshots. The snapshots are an interactive online resource that provides state-level data showing how all 50 states and the District of Columbia performed on more than 250 measures related to health care quality and access. Drawn from AHRQ's 2015 National Healthcare Quality and Disparities Report, the State Snapshots show how each state fared according to National Quality Strategy priorities, prevalence of diseases and conditions, health status of priority populations, insurance status, access to care, type of care and setting of care. While the 2015 report shows progress nationwide in access and care affordability, the State Snapshots reveal substantial variations across states and sizable disparities related to race, ethnicity, income and other factors. Learn more about AHRQ's State Snapshots, which offer easy-to-read charts on the strengths, weaknesses and opportunities for improvement in each state.