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During the first year of the Trump administration, states have grappled with many unanswered questions regarding the new administration’s views on value-based payments (VBPs) and how it would approach state-led or Medicaid based payment reform initiatives. These include to what extent existing efforts will continue to be supported or renewed, what mechanisms states can or should use to implement VBPs (e.g., DSRIP programs, 1115 waivers, 1115A waivers), what financial support will be available, and how much flexibility the Center for Medicare & Medicaid Services (CMS) will grant states in designing and funding innovative models. In the past eight months, CMS has revealed what it will look for in these initiatives moving forward, such as a desire to support state innovation. This paper provides a historical perspective on VBPs, including the health care system’s move away from payment models based on fee-for-service, and an overview of state models focused on value and quality. The paper also outlines the Trump administration’s key signals to date and how they might impact state VBP efforts in 2018 and beyond.
Salt Lake City, February 20, 2018 –Today, Leavitt Partners released “Value-Based Payment in Medicaid: Signals for States,” a white paper that outlines the Trump administration’s key signals to date and how they might impact state value-based payment (VBP) efforts in 2018 and beyond.
Dual eligibles, individuals enrolled in both Medicare and Medicaid, are among the highest-need, highest cost patients in the United States. Although it is difficult to determine the exact number of dual eligibles, a 2012 Kaiser Family Foundation report estimates that dual eligibles comprise 21 percent of the Medicare population and 15 percent of the Medicaid […]
Join Health Intelligence Partners in Nashville, TN for a deep dive roundtable discussion that focuses on the underpinnings of Medicaid reform and evolution that are critical to shore up no matter what policy change comes from Washington, from the perspective of states, vendors and providers: Technology: Where are the opportunities for technology to enable efficiencies […]
The Affordable Care Act turned Medicaid into America’s largest public health care coverage program. While the volume associated with this growing program created increasing opportunities for providers, health systems, health plans, and vendors, these same stakeholders shouldn’t write off opportunities in Medicaid now simply because of the change in direction at the federal level. Instead, […]
On April 26, 2016, CMS released final rules for Medicaid managed care and CHIP, marking the first revamp of these rules in over 10 years. Currently, 39 states and D.C. rely on managed care to provide services to all or a portion of their Medicaid beneficiaries, and that number is growing. The use of managed […]
Last month CMS published a request for comment regarding a proposed change in how services provided by an Indian Health Service (IHS) or Tribal facility are reimbursed under Medicaid. This proposed change could represent a significant shift in reimbursement policy for many states, IHS, Tribes and providers. If it moves forward, this change will align […]
State leaders have been arguing powerfully for greater flexibility in designing and administering their Medicaid programs, particularly when consider using 1115 Demonstrations to implement Medicaid expansions under the Affordable Care Act (ACA). However, while states are pushing for ever more flexibility and control over Medicaid, HHS may believe that it has already gone far in […]
Many states have been forcefully arguing for the Department of Health and Human Services (HHS) to grant extensive flexibility in the state administration of the Medicaid program. While some waivers have been authorized, many other waiver requests have not been granted. Federal controls are not a new concern for states, but the level of interest has […]
No two models nor markets are alike, and the pace and prevalence of Medicaid accountable care growth will largely depend on states’ ability to generate savings and successfully overcome common and unique challenges over the long run. This paper contains a state-by-state landscape analysis.
Leavitt Partners releases “The Rise and Future of Medicaid ACOs,” which contains a state-by-state landscape analysis Salt Lake City, September , 2015 — No two models nor markets are alike, and the pace and prevalence of Medicaid accountable care growth will largely depend on states’ ability to generate savings and successfully overcome common and unique […]
On May 26, CMS released a proposed rule outlining changes and clarifying regulations for state Medicaid managed care and CHIP programs. While many of the changes are minimal or simply solidify practices states are already engaged in, a few areas have the potential to seriously disrupt current state and plan processes. Details of those disruptions […]
As part of a Medicaid waiver, Florida receives over $1 billion in annual Low Income Pool (LIP) funding from the federal government to assist safety-net providers in covering uncompensated care. That waiver expires in June, and the Obama Administration had originally announced that it would consider tying its renewal to state Medicaid expansion for individuals […]
Last month Health Intelligence Partners members convened to discuss the transformation of the Medicaid program over the last fifty years, as well as the projected anticipations of where the program is going. While not unanimous, the top four conclusions reached are noted below. The full analysis is available to download below, as well as by […]
On March 31, the Supreme Court (SCOTUS) ruled that Medicaid providers cannot sue states to assure that payments “are sufficient to enlist enough providers.” Providers are now limited in their legal options. SCOTUS points to one remedy for Medicaid providers: the ability of CMS to withhold funds from states that fail to comply with Medicaid […]
Exclusive to members of Health Intelligence Partners: Medicaid has not only evolved considerably in the last fifty years, but even in the last five. While the expansion from the Affordable Care Act has been one driver, there are other powerful forces including market shifts, system innovation, demographics, technology and ideology that are creating a program […]
2015 will be a pivotal year for employer sponsored insurance. Experts predict a return to higher healthcare spending growth for 2015 as the economy recovers
With an increased focus on health care and Medicaid expansion, states are looking for ways to increase the efficiency and quality of the program.
Medicaid is a paradox. It is routinely considered to be too generous and too stingy; both unreliable and indispensable; and is a program for the poor, although not all people who are eligible are poor and not all poor people are eligible (though this latter point will change significantly in 2014). The Obama Administration is […]
By Dennis G. Smith Dennis G. Smith, Managing Director of Leavitt Partners’ Medicaid Practice, explains the past, present, and future of Medicaid expansion and who it concerns. Before joining Leavitt Partners Dennis was Director of the Center for Medicaid and State Operations (CMSO) at the Centers for Medicare and Medicaid Services.
With the passage of the Patient Protection and Affordable Care Act, the US economy and its health care system will be looking forward to a serious expansion of its charitable health care program, Medicaid. In 2014, eligibility for Medicaid will expand to include income levels of up to 133% of the federal poverty level. This […]
David Muhlestein provided his insights into Allegheny Health Network building a new micro hospital in Westmoreland County, Pennsylvania for an NPR article entitled “Why Health Care Systems Are Building Micro Hospitals.” “This might be a market that has a lot of commercially insured patients, and commercial insurance tends to pay much higher than Medicare and […]
On Thursday, March 22, 2018, HIP hosted a webinar in replace of a table top event (due to weather). We had a great discussion and are excited to continue this conversation at our HIP Annual Meeting in August. In the aftermath of repeal and replace, individual insurance markets in the states are struggling to stabilize. […]
The latest information from the Centers for Medicare & Medicaid Services (CMS) on the number of plan selections for the current Open Enrollment Period (EOP) has been a positive sign for stakeholders that are hoping for a large and stable enrollment cycle. While the number of plan selections has been higher than in the previous […]
Webinar: Thursday, November 16, 2017 Despite foundational challenges, biopharmaceutical companies and payers are finding ways to align forces around mutually beneficial clinical outcome payment programs. Our panelists will discuss how such partnerships can navigate clinical and operational performance requirements, and what are the implications for patient adherence and dissemination of real world evidence. Additionally, we […]
Washington, D.C., October 4, 2017 — Today the National Association of ACOs (NAACOS) and Leavitt Partners released the results from their first Annual ACO Survey in a Health Affairs article entitled “The 2017 Annual ACO Survey: What Do Current Trends Tell Us About The Future of Accountable Care.” Two-hundred and forty unique ACOs, representing one quarter of all known Medicare, Medicaid, and commercial ACOs, participated in the 2017 survey. Results provide an important view into the current state of ACOs as well as their plans for the future.
The findings shed light on ACOs’ participation in other Alternative Payment Models (APMs), common improvement activities, organizational and contract structures, and investments. Andrew Croshaw, CEO of Leavitt Partners, stated “With more than 32 million patients receiving care from ACOs nationwide, ACOs are now an important part of the American health care landscape, and the need to understand them better is becoming increasingly more important. The Annual ACO Survey provides one of the most comprehensive views into the growing ACO industry.”
Survey results indicate that ACOs are becoming more willing to take on financial risk; however, a successful transition to risk will only occur when they have the ability and infrastructure in place to take on and manage that risk. Clif Gaus, Sc.D., President and CEO of NAACOS said, “There are many opportunities to support the ACO movement, especially among policy makers and researchers. Everyone wants value-based care, but in order to do that we need to support, learn, and continuously improve. We’re all learning. Let’s do that together.”
National Association of ACOs: Clif Gaus at 202-640-1898 or firstname.lastname@example.org
Leavitt Partners: Jordana Choucair, senior director of communications, 801.538.5082 or Jordana.Choucair@leavittpartners.com
David Muhlestein reacted to CMS’ announcement that the agency is setting a new direction the Center for Medicare and Medicaid Innovation (CMMI) for a Modern Healthcare article entitled “CMS champions innovation and competition while buoying value-based care.”
The Centers for Medicare and Medicaid Services (CMS) has shown significant support for the development of Alternative Payment Models (APMs). CMS’ development and testing of 45 payment models has led to the adoption of similar models by other payers. Initial reports indicate that APMs could be key to producing the health care delivery reform necessary to decrease health care costs and increase delivery quality. However, these models are only available to select provider types, and some providers, such as emergency physicians and audiologists, have no Medicare APMs in which they can participate. To realize the full benefits of APMs, additional collaboration between CMS leadership and providers is needed to develop new models for providers who do not currently have access to them.
More than 86 million American adults have prediabetes. That number alone is astounding, but perhaps what is even more concerning is that 9 out of 10 people with prediabetes don’t know they have it. Considering that, in the absence of any health intervention, 15‒30 percent of people with prediabetes will develop type 2 diabetes within five years, effective preventive measures are needed to mitigate a serious public health crisis. The Centers for Disease Control and Prevention (CDC) is proactively responding to this potential problem by developing and promoting the National Diabetes Prevention Program (National DPP) lifestyle change program.
An Arkansas Times article entitled “DHS announces ‘one-stop-shop’ for Medicaid providers” notes that Leavitt Partners helped to design a new division, called the Division of Provider Services and Quality Assurance, that will certify, license, monitor, and inspect all Medicaid providers for all of the DHS.
A Governing article entitled “The Best and Worst States for Medicaid Managed Care, According to Patients” and a Pharmacy Choice article referenced Leavitt Partners’ KanCare report. The article states, “But a report published last November by the Leavitt Partners consulting firm determined that KanCare had delivered on the cost savings, but not the quality metrics.” (Governing article here, Pharmacy Choice article here)
The Comprehensive Care for Joint Replacement (CJR) bundled payment model is a Centers for Medicare and Medicaid Services (CMS) initiative that is designed to incent hospitals to reduce the widespread cost variation in hip and knee replacements, and post-operative hospital readmissions throughout the United States. Originally announced in 2015 and revised in 2017, hospitals in
34 markets will be required to participate in the model, including being subject to downside risk, beginning January 1, 2018.
According to the National Institute on Drug Abuse and the CDC, in 2015 over 33,000 people died from opioid overdose in the United States, and in 2013 prescription opioid abuse cost the U.S. economy approximately $78.5 billion in costs related to health care, crime, and loss of productivity. Opioid abuse and the related overdose deaths […]
Given the well-publicized challenges with the individual market, carriers’ product development and pricing process for 2018 has been particularly difficult. In an effort to give insurers some reprieve, last week the Centers for Medicare and Medicaid Services extended the deadline for issuers to make changes to their rate filings from August 16 to September 5. However, […]
In the U.S., a person’s health status is impacted by a variety of factors such as race/ethnicity, disability status, socioeconomic status, age, gender, sexual orientation, geography, and more. These differences in society are linked to inequalities in health status that are referred to as health care disparities. The CDC defines health disparities as “preventable differences […]
Where Are ACOs Headed? At this pivotal time in the accountable care movement, future ACO growth will determine whether accountable care moves from a series of exploratory programs toward mainstream adoption across the country. A significant contributor to future growth is the success of today’s ACOs and their continued involvement in the ACO model, which […]
Laura Summers weighed-in on the impact of Illinois’ budget crisis on Medicaid health insurers for a Crain’s Chicago Business article entitled “The problem in Illinois no one is talking about.” Laura noted that the situation, which has resulted in insurers being owed a combined $3 billion of the state’s roughly $15 billion in overdue bills, could be creating “less of a willingness to find new members.”
Laura Summers weighed-in on the impact of Illinois’ budget crisis on Medicaid health insurers for a Crain’s Chicago Business article entitled “The problem in Illinois no one is talking about.” Laura noted that the situation, which has resulted in insurers being owed a combined $3 billion of the state’s roughly $15 billion in overdue bills, […]
Today (Friday, June 30), Health Affairs Blog published “State Single Payer And Medicaid Buy-In: A Look At California, New York, And Nevada.” The piece – written by Douglas Hervey, Sean Mullin, and Austin Bordelon – examines high-profile state-driven solutions to address consumer access and price related concerns developed by three states. The authors note that […]
Robin Arnold-Williams provided her thoughts on the BRCA’s provisions to equalize payments to the states for a Modern Healthcare article entitled “Would Senate bill’s extra payments to non-expansion states offset overall Medicaid cuts? Hospital groups say no way.” “It’s a complex puzzle of a variety of incentives and disincentives,” said Robin Arnold-Williams. “Some states will […]
Dual-eligible enrollees account for a disproportionately sizeable proportion of spending in both Medicare and Medicaid programs. However, until recently, these nearly 11.5 million[i] enrollees have not been in the spotlight in discussions regarding the move toward value-based payments.
As telehealth gains traction as a way to deliver health care, Medicare reimbursement remains a major obstacle to broad implementation due in part to scoring methodology from the Congressional Budget Office (CBO). Rather than decreasing health care costs, CBO’s scoring methodology assumes that telehealth increases utilization and therefore overall costs. Recent legislation on the Hill, […]
On April 1, 2016, the Comprehensive Care for Joint Replacement (CJR) model program took effect, affecting roughly 800 hospitals across 67 markets. Prior to the program becoming active, Leavitt Partners published a blog post stating, “Time will tell whether hospitals and providers will succeed with quality improvements and savings generation under this new program.” One […]
Introduction During the 1970s, in an effort to limit rising health care expenditures, several states adopted various forms of all-payer rate-setting models, where all payers pay the same price for services at a given facility. Over time, most state models failed and only Maryland’s all-payer hospital rate-setting system remains. Recently, there is renewed interest in […]
Background The Centers for Medicare and Medicaid Services (CMS) has initiated a process whereby physicians and other stakeholder entities can design physician-focused payment models (PFPMs) that fit with their clinical practices, while also providing better outcomes for patients, and recommend such models to the Health and Human Services Secretary (the Secretary) for consideration and/or further […]
Background The Quality Payment Program (QPP) under MACRA is now more than three months underway into the first payment year. However, there are still many nuances of the program, specifically under the multi-payer Advanced APM option, that payers —including commercial, Medicare Advantage, and Medicaid — and clinicians need to understand before they can begin collaborating, […]
Bundle payment models, including the Bundled Payments for Care Improvement Initiative (BPCI), are an important part of the episode-based health care value transformation. However, they are also under increased scrutiny, in part due to strong concerns among some Republicans regarding mandatory models as well as the idea that they do little to curb the volume […]
A RCM Answers article entitled “What’s Happening with Value Based Reimbursement in 2017” references the Leavitt Partners “Projected Growth of Accountable Care Organizations (2015)” white paper, stating that “In 2015, Leavitt Partners estimated almost 800 Medicare, Medicaid and Commercial ACOs covering over 23 million lives, and projected that number to grow to over 2600 covering […]
Join us for our next HIP webinar on April 20th to hear from special guests David Muhlestein, Ph.D., J.D., Vice President of Research at Leavitt Partners, and Art Jones, MD, Principal at Health Management Associates (both bios below). How is accountable care progressing (with new data from NAACOs) and what does the industry need to do […]
A USA Today article entitled “Obamacare overhaul proposals create uncertainty for patients, providers” includes commentary from Governor Leavitt regarding ACA repeal and replace options for Medicaid. Governor Leavitt, referencing a request he received from Republican members of Congress to come up with a formula to divide block grant money among the states during his time […]
Legislative changes in Washington promise significant disruption of ACA marketplaces, state Medicaid programs, and possibly self-insured employer benefits. Major questions exist about how insurance markets will adapt and thrive. What does it take for state marketplaces to endure – and what changes would be needed at the federal and state level to support that evolution? […]
An article entitled “Pediatric Accountable Care Organizations: Insight From Early Adopters,” which was co-authored by Tom Merrill and David Smith, was published in the January edition of Pediatrics. The article highlights research findings from a study conducted by the American Academy of Pediatrics and Leavitt Partners, including a series of five case studies of diverse […]
A Hillsboro Free Press article entitled “Seniors, care homes burdened by state’s Medicaid backlog” cites Leavitt Partners KanCare project. The article states, “Leavitt Partners, a health policy consulting shop, released a report on KanCare last month that touched briefly on the application backlog. The report — commissioned by the Kansas Hospital Association, Kansas Medical Society […]
Robin Arnold-Williams provided insight into the future of block grants for a Provider article entitled “Medicaid’s Future Depends on Extent of Republican Changes to Come.” Robin noted that capping funding is not an easy task and that the level of capped funding is a major concern for states. “What we know about Medicaid is that […]
Emergency medical services (EMS) evoke images of EMTs and paramedics responding to medical crises and transporting patients to the hospital rather than thoughts about value-based care and changes in health care delivery and payment models. EMS leaders are trying to change that paradigm through a movement dubbed “EMS 3.0.” EMS 3.0 aims to make emergency […]
Governor Leavitt shared his thoughts on the future of the ACA during Conversations on Health Care, a weekly radio show produced by Community Health Center, Inc. Governor Leavitt said, “, “The one certainty in the next several months about health care is that there will be a bill that will pass Congress that will be […]
David Muhlestein discussed the future of MACRA for a Managed Care Magazine article entitled “What Does Trumpcare Mean for the Future of ACOs?” David said that MACRA was a bipartisan piece of legislation and that the ACO trend is much larger than the ACA and the CMS ACOs it spawned. The article also notes that […]
The Centers for Medicare and Medicaid Services assigns a star rating to Medicare Advantage plans to help beneficiaries better understand and select their insurance plan. When selecting an insurance plan, quality and cost are typically the top selection criteria used. This study looks at the relationship between these two important factors – quality (in star […]
On Wednesday, Governor Leavitt participated in a National Institute for Health Care Management Foundation panel regarding the future of health care in America. Governor Leavitt discussed what is currently occurring in the ACO movement and said that there are three topics that the new administration and Congress will deal with in early 2017: fragile individual […]
Not Losing Sight of the Dual Eligible in the Move to Value Based Payments Value-based payments arrangements are increasing. While most of this movement is being driven through Medicare-based payment initiatives, CMS is now increasingly pushing value-based payments in Medicaid based on the success CMS has achieved in Medicare. The shift to value-based payments is […]
Medicare Advantage (MA) offers Medicare benefits through private health plans, providing an alternative to the traditional, federally-administered program. Also known as Medicare Part C, this private option traces its roots to the 1970s and received its current name and form in the Medicare Modernization Act of 2003. Since then, the number of enrollees has grown […]
Insurance premiums under the Affordable Care Act (ACA) are receiving increased attention due to reports of sharp 2017 increases by insurers. Across the nation, insurers have submitted initial premium increases and it is not uncommon for insurers to submit proposed rate increases in excess of 40-50% for 2017. State regulators will review the requests meticulously […]
Salt Lake City, UT – August 10, 2016 – Leavitt Partners and Forward Health Group have announced a collaboration to support physician groups and payers succeed in Comprehensive Primary Care Plus (CPC+), a payment initiative set forth by the Centers for Medicare and Medicaid Services (CMS). Primary care medical practices must apply for CPC+ by […]
A Hospitals and Health Network article entitled “All Roads Lead to Population Health Management” cited Leavitt Partners ACO data. The article notes: “Approximately 750 accountable care organizations are in operation today, covering some 23.5 million lives covered under Medicare, Medicaid and private insurers. Although still in the learning stages, many ACOs have had notable success […]
Leavitt Partners releases “Comprehensive Primary Care Plus (CPC+): Transformational Physician Managed Care,” a white paper that assesses the recently announced CPC+ initiative and its implications on various segments of the health care industry. Salt Lake City, June 7, 2016 — The “Comprehensive Primary Care Plus (CPC+): Transformational Physician Managed Care” white paper, released today, lays […]
While primary care is the foundation for effective population health management, traditional reimbursement structures under fee-for-service (FFS) do not facilitate the delivery of high-quality primary care. The April 11, 2016 announcement of the Comprehensive Primary Care Plus (CPC+) program by the Centers for Medicare and Medicaid Services (CMS) marked a sweeping move to transform the […]
Risk adjustment in its simplest form is a process that transfers funds from issuers with relatively lower risk enrollees to issuers with relatively higher risk enrollees to protect against adverse selection. However, the mechanics behind this process are quite complex and from its inception there was a lot of uncertainty and debate about how effective […]
Leavitt Partners recent “Ten Early Takeaways from the Medicare Shared Savings ACO Program” whitepaper was highlighted in a FierceHealthFinance article, entitled “Emerging quality and savings trends outline challenges and promise of ACO model.” The article notes that “In order to get a read on the effectiveness and ultimate viability of transforming an organization into an ACO, Leavitt combined the public performance data provided by the Centers for Medicare & Medicaid Services (CMS) with information from its own proprietary database” and briefly describes three of the emerging trends.
Amid a firestorm of protest, the Obama administration announced a new test model for how it will pay for Medicare Part B drugs. According to the administration, this move is in line with recent changes to payment methodologies from the Centers for Medicare and Medicaid Services (CMS) in an effort to curb escalating medical spend […]
On Super Tuesday, the frontrunners gained key victories in pivotal states, increasing their respective leads for the presidential party nominations. Donald Trump won across the South and in New England, while Hillary Clinton took command of the Democratic race, rolling to victories in Texas, Virginia, and across the South. The delegate count now appears to […]
On Friday, the Centers for Medicare and Medicaid Services (CMS) announced their proposed Medicare rate adjustments. Estimates forecast a 3.5% increase for Medicare Advantage plans after adjusting for coding practices. CMS also intends to “improve payment precision and encourage quality” with the possibility of some changes to the star rating system. The proposed changes represent […]
Earlier this year, CMS announced a new clinical-community collaboration program to overcome the unmet social needs of beneficiaries. The Accountable Health Communities Model (AHC) will examine whether systematically identifying and attempting to address health-related social needs of beneficiaries through referral and community navigation services can impact health care costs, reduce inpatient and outpatient health care […]
On November 16, 2015, the Centers for Medicare and Medicaid Services (CMS) finalized the Comprehensive Care for Joint Replacement (CJR) model, its first mandatory bundled payment initiative. The final rule made several major changes to the CJR program, including that the program’s start date would be delayed to April 1, 2016 (a four-month delay).
Health Affairs releases “How Might Proposed Mergers Impact State Insurance Markets?” blog containing a state-by-state landscape analysis. Salt Lake City, December , 2015 — With recent news of the proposed Aetna/Humana, Anthem/Cigna, and Centene/Health Net mergers, a number of stakeholders have raised questions about how consolidation impacts health care markets’ competitiveness. For these proposed deals, […]
Robin Arnold-Williams was interviewed for a POLITICO Pro article entitled “CMS Proposed Change Contains Medicaid Expansion Angle” regarding what states could benefit from CMS’s proposed policy to loosen up some of the conditions for when the federal government fully funds services for Medicaid-eligible American Indians and Alaska Natives. The proposed change would free up more state money to cover Medicaid expansion costs beginning in 2017. Although some non-expansion states like South Dakota and Oklahoma could benefit, Robin noted that it might not be the deciding factor for many other states.
Recently, the Centers for Medicare and Medicaid Services (CMS) announced that more providers have decided to assume financial risk under Phase 2 of the Bundled Payments for Care Improvement (BPCI) program. Launched in January 2013, the BPCI Initiative has offered providers an opportunity to pursue 48 episodes of care within four different types of bundled […]
The Comprehensive Care for Joint Replacement (CCJR) program, recently announced by The Centers for Medicare & Medicaid Services (CMS), establishes a new five-year program model to support better and more efficient care for common inpatient surgeries, specifically hip and knee replacements, at hospitals in 75 MSAs. Soon, hospitals will be influenced to decide whether or […]
We are leaving a period of horizontal payer M&A, focused on nascent, highly-strategic transactions, and entering a period where faster and more pervasive consolidation is likely. This should not surprise anyone. The virtual commoditization of traditional payer functions (medical management, lives aggregation, administration, network management, etc.) through the passage of the Affordable Care Act and […]
KELBY K. KRABBENHOFT, President and Chief Executive Officer of Sanford Health, is responsible for the overall vision and direction of this organization. Sanford Health is an integrated health system headquartered in the Dakotas and is now the largest rural, not-for-profit health care system in the nation with locations in 132 communities in five states, with […]
In contrast to the 13 ACOs that very publicly left the Pioneer program, 27 participants have quietly disappeared from the Medicare Shared Savings Program (MSSP). Research by Leavitt Partners has found that while some of these MSSP ACOs have indeed left the program, most of the “missing ACOs” are the result of mergers with other […]
Academic Medical Centers (AMCs) are a vital part of the U.S. health care system. They train doctors, find new treatments and cures, and in many cases, care for the sickest and most complex patients at their facilities. AMCs also provide important community services, and are critical to America’s safety net. AMCs in today’s world of […]
We write to the governors and legislative leadership of 34 states with the aspiration of using our collective experience as former officials from the Department of Health and Human Services (HHS) to share an analysis that may be helpful in anticipating options ahead of the King v. Burwell court ruling. Within the next two weeks, […]
Salt Lake City, June 9, 2015 — Leavitt Partners, in collaboration with the American Dental Association and the American Academy of Pediatric Dentistry, today published “Dental Care in Accountable Care Organizations: Insights from Five Case Studies.” This paper examines five Accountable Care Organizations (ACOs) that have integrated oral health services into their care delivery model. […]
Variability in Prostate-Specific Antigen (PSA) Testing Across the United States During the past few years the Centers for Medicare & Medicaid Services (CMS) has increasingly been willing to release data that allows analysts to study treatment patterns for individual physicians. This has been extensively covered by the media, particularly as it relates to high-paid physicians. […]
For nearly five years, Leavitt Partners has led the nation in tracking and analyzing the growth and geographic dispersion of Medicare, Medicaid and commercially formed Accountable Care Organizations. Newly released numbers through the Health Affairs Blog note that: 744 ACOs now exist in all 50 states and cover 23.5 million lives 132 different health insurance […]
As public insurance marketplaces mature and pursue long-term sustainability, their willingness to continue supporting Navigator Programs may wane – leaving the future of the health care law’s hallmark consumer assistance program in question. Section 1311(i) of the Affordable Care Act (ACA) established the Navigator Program as a mandatory function of the health insurance marketplaces. The […]
As technology continues its rapid advance, telemedicine is becoming much more relevant as a means of expanding care delivery options. While telemedicine is limited in its scope for certain services, it continues to evolve as a key component in primary care as organizations seek to more efficiently and effectively manage the care of their patient […]
Today, Charlene Frizzera, senior advisor at Leavitt Partners and former CMS acting administrator, will address the Medicaid and CHIP provisions in the ACA at a Kaiser Family Foundation and the Alliance for Health Reform briefing. The briefing will take place at 10:00am MT/12:00pm ET.
The Rise of a GOP Option In 2014, GOP leadership took a decisive step to shape the repeal and replace philosophy through the introduction of the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act. The legislation, co-authored by Senators Richard Burr (R-N.C.), Tom Coburn, M.D. (R-Okla.), and Orrin Hatch (R-Utah), was deemed as “a legislative […]
This post is a four-part series on state health care innovation efforts. This post will give a broad overview of some of the opportunities available to states that support their efforts in transforming health care payment and delivery systems. Upcoming posts will discuss each of these opportunities in more detail. The Affordable Care Act (ACA) […]
The biggest challenge to the Patient Protection and Affordable Care Act (“ACA”) isn’t a Republican controlled Congress, public-opinion, or a government website glitch. It is the Supreme Court. The Court will soon decide whether millions of consumers residing in the 34 states using the federally-facilitated insurance marketplace (FFM) will become ineligible for subsidized coverage.
In 2013, the Department of Health and Human Services (HHS) issued final rules for the Affordable Care Act’s (ACA) essential health benefit package (EHB) package. The rules require states to designate “benchmark plans” that cover 10 expansive categories of essential benefits, including preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs.The […]
For states looking to ease in step-by-step with State-Based Marketplaces, the Supported State-Based Marketplace appears to be that practical option.
Known as private, nonprofit organizations, CHCs have grown up over the years, and aren’t just considered the safety-net option for care anymore.
Leavitt Partners was cited in a NewsOK article examining good reasons to expand Medicaid in Oklahoma. The article notes that Leavitt Partners is credited with having determined that the uninsured Oklahomans who could be covered suffer higher rates of serious health problems than current Medicaid enrollees.
A team from Sellers Dorsey and Leavitt Partners assisted the Commonwealth of Pennsylvania in drafting the 1115 Demonstration waiver request to ensure compliance with state and federal regulations and the Governor’s Healthy Pennsylvania framework to promote personal responsibility, healthy behaviors and improved health outcomes. The Commonwealth reached an agreement with CMS regarding the state’s initiate to reform the Medicaid program and provide private insurance to uninsured residents.
State health care innovation is accelerating, with many states developing initiatives to further their efforts to improve health care.
A Health Affairs blog post by Leavitt Partners researchers Matthew Petersen and David Muhlestein compiled results from Pioneer, MSSP, Medicaid and commercial ACOs. Results are limited at this point but provide some insight into how the various ACO programs are progressing. Examining reported results also provides a rare glimpse into the quality measures being used by commercial ACOs.
Leavitt Partners releases “Variation in Health Care Provider Concentration: A National Visualization”, which assesses provider supply within the United States
Like Billy Beane, the Coalition has embraced unconventional wisdom and today represents one of the country’s most integrated and effective care networks
The combination of ACOs and online marketplaces could represent a real win for consumers when shopping for health insurance coverage.
Douglas Hervey’s blog post “What You Should Know About Medicaid ACOs” was posted in Becker’s Hospital Review. Douglas speaks to certain state ACO initiatives, and addresses the question of why high-level hospital leaders should be following local state- level Medicaid ACO initiatives.
The Basic Health Program (BHP) provides flexibility to states to design a health coverage option to better meet the needs of their low-income population.
Achieving access to services for those who need care is on the mind of all health systems around the country.
Mientras que las Organizaciones Responsable por el Cuidado de la Salud (ACO)han proliferado en los últimos tres años, la adopción extendida del modelo no ha prevenido criticismo. Críticos, sin embargo, no siempre toman en cuenta la panorama entera. En mi papel como encargado de la investigación primaria en El Centro para la Inteligencia del Cuidado […]
Accountable Care Organizations (ACOs) have been developed throughout the country, but the total size of the population covered by public and private ACOs is largely unknown. In this paper we present estimates of ACO penetration throughout the country. Despite a recent slowdown, ACOs have continued to proliferate and more lives are being covered by accountable care contracts than ever before. ACOs […]
What works and 8 lessons other health care organizations learn
Douglas Hervey, Coordinator of ACO research at Leavitt Partners, outlines six key takeaways from Medicare’s first year report on thier Shared Savings Program.
Charlene Frizzera, Laura Summers and Michael Deily presented a report on June 27 to the governing board of the Oklahoma Health Care Authority recommending that Oklahoma should use its existing Insure Oklahoma program as a framework to take advantage of increased federal Medicaid funding and expand health insurance coverage to over 200,000 low-income uninsured residents.
On June 27, Charlene Frizzera, Laura Summers and Michael Deily presented a report to the governing board of the Oklahoma Health Care Authority recommending that Oklahoma should use its existing Insure Oklahoma program as a framework to take advantage of increased federal Medicaid funding and expand health insurance coverage to as many as 274,000 low-income uninsured residents.
Leavitt Partners has launched LP Health Speakers, an experienced and knowledgeable selection of health care visionaries and thought leaders who are available to deliver keynote addresses, moderate and participate in panels, speak at retreats, facilitate strategic discussions and conferences, and brief senior executive teams. The firm is pleased to feature more than a dozen health care […]
SALT LAKE CITY, (November 29, 2012) — A comprehensive and cutting-edge report co-authored by Leavitt Partners and KLAS Research shares detailed information about the structure, maturity, partnerships, practice and payment arrangements of Accountable Care Organizations (ACOs) throughout the country. The report, which represents the culmination of months of survey research and analysis, is based on a […]
Giving patients more control over, and visibility into, health care spending decisions, will contribute to a better functioning health care marketplace.
As cost concerns mount and workforce shortages continue, telehealth will provide a useful way to support long-distance clinical care.
SALT LAKE CITY, (Oct. 30, 2012) — With the 2012 election a week away, Leavitt Partners today released analysis that shows the critical impact the elections will have on the implementation of the Affordable Care Act. Hanging in the balance is the execution of federal health reform as determined by the White House, Congress, statehouses and America’s private […]
SALT LAKE CITY, (May 31, 2012) — In anticipation of the forthcoming Supreme Court decision on the federal health reform law, Leavitt Partners has analyzed how various rulings by the court, when combined with 2012 election results for the White House and Congress, may impact the future of American health care. The analysis draws upon the […]
David Muhlestein — Analyst at Leavitt Partners — describes and compares the reasons why health insurance exchanges will be disruptive to our current way of delivering health insurance. The Patient Protection and Affordable Care Act (ACA), considered the most important piece of federal health care legislation since the creation of Medicare and Medicaid[i], has been […]
Leavitt Partners FuturePanel™ member and senior advisor Charlene Frizzera will speak at the 2012 LTC 100 Leadership and Strategy Conference being held May 5-8 at the Ritz-Carlton Naples Beach, Florida. The conference will focus on affirming skilled nursing’s role in the evolving health care system. LTC 100 is the premier conference for executives in skilled […]
Most of the time these days, I lament my age and the conditions that come with it. But as I have come to this point, I have had the opportunity for many experiences. It is my sincere hope that these experiences can help inform the future. In 1983, I served as a Charter member of […]
Salt Lake City (Feb. 28, 2012) — Leavitt Partners today announced the formation of Health Intelligence Partners™, a member-based, health care executive collaboration. The collaboration brings together industry leaders and policy experts to participate in tailor-made health care intelligence activities that give members an informed perspective on the likely future of health care. Skillfully executed national surveys, […]
Leavitt Partners has created FuturePanel™, an authoritative group of health care thought leaders who inform, refine and guide the health care intelligence shared by the firm. FuturePanel members include former senior executives from the Centers for Medicare and Medicaid Services, national leaders in health information technology, veterans of state-level health care policy, clinical experts and […]
States will experience a significant increase in Medicaid populations in 2014 due to the recently passed Patient Protection and Affordable Care Act. Leavitt Partners’ Andrew Clark outlines the risks these new populations may bring and explains why an investment in behavioral health management could be a solution. As a result of the Patient Protection and […]
Federal health care reform has given states a tight timeline for the implementation of state health insurance exchanges. Is the reform requiring too much too fast? Cheryl Smith, a Director at Leavitt Partners, shares her view. A Deep Breath and a Step Back I recently attended a conference in Washington, D.C. in which a number […]
An article by Michael O. Leavitt and Tevi Troy published by TheHill.com on September 20, 2011. Governor Leavitt was Health and Human Services secretary from 2005 to 2009. Tevi Troy, a senior fellow at the Hudson Institute, was deputy HHS secretary from 2007 to 2009, and a senior White House aide from 2005 to 2007. […]
Dr. John Nelson outlines how pay cuts will likely widen gap between smaller and larger hospitals. An interesting article suggests that the disparity between affluent hospitals and those that are struggling may widen under health system reform.1 The article points out in a credible fashion why this may be so. Smaller hospitals that are less […]
The Standard & Poor’s rating agency announced Friday that it has downgraded the U.S. credit rating to AA+ from its top rank of AAA. Andrew Croshaw shares his thoughts. Much has been written about the appropriateness of Friday’s U.S. credit downgrade by Standard and Poor’s from AAA to AA+. Some argue it was politically motivated, […]
Millions of people will gain insurance under the Patient Protection and Affordable Care Act. The common wisdom claims that these newly insured with health reform will overcrowd the system, but do the numbers agree? The Congressional Budget Office (CBO) estimates that under the Patient Protection and Affordable Care Act (PPACA) 21 million people will become […]
Michael O. Leavitt is a member of the Deseret News Editorial Advisory Board. The following op-ed was published in the Deseret News July 17th, 2011. The nation’s governors met for their annual meeting in Salt Lake City this week. Governors enjoy this opportunity to learn from and occasionally commiserate with peers dealing with similar challenges. […]
In an op-ed published in The Washington Times, Leavitt Partners founder and chairman Michael O. Leavitt argues that the best approach to health reform is to allow states to innovate and design approaches that meet state-specific needs. As a former HHS secretary and governor, Leavitt has experience on both sides of the federal-state partnership to […]
In recent weeks health insurance exchanges have become the target of those who oppose Obamacare. This is very unfortunate as exchanges make sense for a number of reasons and exchanges should not be used as a scapegoat to defeat Obamacare. Medicaid expansion is surely the elephant in the room and should be the topic of […]
The PPACA bill is estimated to provide health care coverage for another 30 million U.S. citizens, substantially reducing the population of uncovered persons. This will likely increase demand for health care services, and the laws of economics indicate that when demand increases and supply remains constant, one of two things can happen. Either prices will […]
Michael O. Leavitt was the secretary of the U.S. Department of Health and Human Services (HHS) from 2005 to 2009. Thomas Barker is a partner with Foley Hoag, former acting general counsel for HHS and general counsel to the Centers for Medicare and Medicaid Services. Washington Times Years ago, Washington was rocked by revelations that […]
By Michael O. Leavitt Friday, February 18, 2011The Washington Post Shortly after being appointed to the Cabinet in 2003, I sought the advice of one of my predecessors. He cautioned me to be prudent in exercising the considerable regulatory power Congress had granted these offices, noting: “The place has more power than a good person […]
By Lauren Kelley. As the House prepares to vote on the Continuing Resolution for the FY2011 Federal budget, and as Congress reviews President Obama’s FY2012 budget proposal, I’d like to share my perspective on Community Health Centers. Currently, the House is considering a $1.3 billion reduction in Federal funding for Community Health Centers in FY2011. […]
Michael O. Leavitt is the newest member of the Deseret News Editorial Advisory Board. On Tuesday, Jan. 18, 2011 the following column was published by Desnews.com. On Wednesday, Jan. 19, 2011 the U.S. House of Representatives voted to repeal PPACA. By Michael O. Leavitt On Wednesday, it appears the U.S. House of Representatives will vote […]
Cancer is one of the most significant health care problems that our society faces, impacting millions of citizens in the United States. It is the second leading cause of death in the country. According to the American Cancer Society, there will be over 1.5 million new cancer diagnoses and over 550,000 deaths attributable to cancer […]
The Moment of Truth, the Report of the National Commission on Fiscal Responsibility and Reform (popularly referred to as “the Debt Commission”),* gets high marks for sounding the alarm about the “crushing debt burden” that threatens the chances of our children and grandchildren to have a better life than we currently enjoy (and perhaps, take […]
The increase in the number of unmarried couples living together has once again been in the news. Fifty years ago, 72 percent of all adults were married; today, only about half of all adults (52 percent) are married according to a recent survey by the Pew Research Center. Moreover, 44 percent of all adults and […]
While the Patient Protection and Affordable Care Act (PPACA) is obviously a sweeping piece of legislation, there is a law more powerful to which even the PPACA is subject—the law of unintended consequences (LUC). Economists have warned about unintended consequences for centuries. But we don’t really need to consult economists on this matter as we […]
The U.S. District Court in the Eastern District of Michigan has handed down the first decision in one of the several legal challenges to the Patient Protection and Affordable Care Act (PPACA). While the decision itself may have little or no immediate impact because it will certainly be appealed, the logic used by the Court […]
By Dennis G. Smith The six month anniversary of enactment of the Patient Protection and Affordable Care Act (PPACA) coincided with the last full week of the major league baseball regular season. The intersection of these occasions presents an opportune time to review the appropriate role of an umpire. An umpire is needed to fairly […]
Get ready, America, for what you will need to know in order to how to spend your share of nearly $100 billion in 2014 under the Patient Protection and Affordable Care Act (PPACA). Let’s translate the “want ad” above by following the money: PAC means premium assistance credit. These credits are new entitlement subsidies that […]
Whether a coincidence or not, the Kaiser Family Foundation (KFF) and the Health Research and Educational Trust (HRET) released their annual survey of employer-sponsored health benefits just in time for the Labor Day weekend. If it were a hotdog, it would come with “the works.” Great gobs of data ooze from more than 200 pages. […]
By Dennis G. Smith. During the late 1970s, Saturday Night Live (SNL) featured a skit with Chevy Chase and Gilda Radner in which Ms. Radner, in the character of Emily Litella, would provide her views on topics of the day. After informed by the news anchor (Chase) that she misunderstood the topic, Litella would sheepishly […]
How many times has this famous beginning of Gertrude Stein’s stanza of her poem, “Sacred Emily,” been repeated in the nearly 100 years since it was published in 1913? While numerous interpretations have been offered regarding its meaning, it seems that Stein was not merely explaining the obvious, she was trying to restore the identity […]
The temperature hit 100 degrees in the nation’s capital and the Patient Protection and Affordable Care Act (PPACA) turned 100 days old during this July 4th holiday week. Even though Congress is on recess this week, there is a still lot of health care in the news. July 1 marks the beginning of fiscal year […]
Dennis G. Smith Earlier this month, an umpire’s mistake cost Detroit Tigers pitcher Armando Galarraga the chance to record a perfect game—27 batters, 27 outs without any opposing player reaching base. Galarraga would have been only the 21st person in the 135 year history of major league baseball to achieve this distinction. How rare is […]
Fresh evidence from the Congressional Budget Office (CBO), the Rockefeller Institute, and the National Association of State Budget Officers (NASBO) reveals that the red ink of state and federal budgets continues to spread and structural flaws in government programs will need to be corrected before the national economy returns to good health. CBO Director Douglas […]
While I have profound disagreement with what President Obama and the Democratic congressional leadership did with passage of the Patient Protection and Affordable Care Act (PPACA), their moment of jubilance is understandable. It was a significant legislative accomplishment. I, too, advocated large-scale reform of our nation’s health care sector. Were the outcome mine to […]
The classic fables of Aesop continue to entertain and enlighten some 2,500 years later. It takes little imagination to relate many of his fables to today’s ongoing debate over the new health care law, the Patient Protection and Affordable Care Act (PPACA). Although he could have never imagined today’s medical technology, his understanding of human […]
With the “Patient Protection and Affordable Care Act” signed into law, President Obama has embarked on a tour to sell the package to a skeptical American public. One of the first stops was Iowa. Recalling the immortal lyrics of Meredith Wilson’s “Iowa Stubborn” from the Music Man, it will probably take more than a whistle […]
On February 12, 2010, the White House invited the congressional leadership to a bipartisan meeting on February 25 at the Blair House to discuss health legislation. Since then, there has been much speculation about a new proposal from President Obama that would meet his four- part test to: • Bring down costs for all Americans […]
But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance abuses, let me know. -President Obama, State of the Union, January 27, 2010 Let us adopt President Obama’s words as the aspiration of all Americans and […]
Federal health care legislation came to a screeching halt last week with the Massachusetts Special Election that has sent Scott Brown to the U. S. Senate. Brown opposes the federal legislation in its current form and represents the 41st vote needed to block further consideration of such legislation by the Senate. It is important to […]
During the mid 1990s, I met Dennis Smith. He was working for Senator (William) Roth of Delaware, who at the time was Chairman of the Finance Committee. He was quiet and thoughtful, always considerate despite the considerable stature he had as a senior Congressional staff leader. I was among a small group of Governors from […]
There is a new portrait hanging in the Great Hall of HHS Headquarters in Washington, D.C. It is of former Secretary Tommy Thompson, who I followed as Secretary here at HHS. Governor Thompson’s portrait joins a collection of the other 18 Secretaries who have served since HHS became a Department. I have a long friendship […]
Last week John E. McDonough responded to my entry on SCHIP by making a couple of statements that are typical of those I’m hearing about SCHIP, so I will respond. John’s comment: First, though you decry New York State’s proposed expansion of SCHIP eligibility to 400%fpl, you and the President ignore the fact that the […]
How deficit driven reimbursement could dictate future health care investment. I have three kids. All girls ages three, two and one. As their father and “authority” figure, I regularly allow them to do their own thing until something seems to get out of hand, then I intervene and regulate. But frankly, underneath all the […]
By Dennis G. Smith As Congress prepared to leave town for the Memorial Day recess, there was still a lot going on in health care. Looking back at last week’s events brings to mind a Will Rogers quip, “I don’t make jokes. I just watch the government and report the facts.” With that in mind, here is […]
Leavitt Partners today announced a seasoned team to advise vendors, insurance carriers, brokers and states on the process, policies, politics and people necessary to design and implement health insurance exchanges. The new national health reform law (Affordable Care Act) requires states that do not want a federally-run exchange to have functioning state or regional exchanges […]
Two leading experts in the development and implementation of health insurance exchanges have joined Leavitt Partners. Cheryl Smith and Dan Schuyler, who directed one of only two health insurance exchanges in the country, will serve as directors in the Leavitt Partners health insurance exchange practice. They join a seasoned team of health policy experts who advise technology vendors, […]
Lots of people handicap elections. Very few take the next step and say what it means for health reform. Borrowing from the time-worn tradition of creating brackets for various sporting events, Leavitt Partners introduces Health Reform Bracketology, a systematic analysis of various election outcomes and what it means to the implementation of the Patient Protection […]