In The News

LAN Survey: 40% of Health Payments Tied to Alternative Payment Models in 2020

Fierce Healthcare
Roughly 40% of U.S. healthcare payments were tied to alternative payment models (APMs) last year, with Medicare Advantage claims representing the largest amount, a new survey found.
The survey, published Wednesday by the Health Care Payment Learning & Action Network, showed that more work needs to be done as most healthcare payments were still tied to a fee-for-service model.
“The survey shows we have made limited progress in moving away from fee for service between 2019 and 2020,” said Mark McClellan, M.D., Ph.D., director of Duke University’s Margolis Center for Health Policy and co-chair of the LAN CEO forum, during the LAN Summit Wednesday. “Most payments are still in fee-for-service, especially outside of Medicare.”
The report found that 38.2% of healthcare payments in 2019 and 40.9% of payments in 2020 were tied to an APM. The percentage of payments tied to value increased from 35.8% in 2018.
However, the percentage is below the network’s goal of 50% by 2018.
The network surveyed 73 health plans, five Medicaid states and traditional Medicare, representing 80% of the national market.
LAN also looked at the percentage of healthcare payments along payer types. Medicare Advantage had the highest amount of dollars tied to an APM, with 50% in 2019 and 58% in 2020.
Meanwhile, the commercial insurance business had 32% of its dollars in an APM for 2019 and only slightly increased to 35% the next year.
Traditional Medicare payments stayed relatively flat from 2019 to 2020, with nearly 42% in 2019 and 42.8% last year. But payers broadly support shifting toward value-based care. LAN found that 92% of respondents believe APMs can lead to better quality of care, and 85% think it can lower costs.
However, key challenges are a willingness among providers to take on financial risk and the ability to operationalize those risks…

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Omicron Variant Will Dominate in U.S. Within Weeks, Fauci Says


The omicron variant of the Covid-19 virus will assume a dominant role in the U.S. “very soon,” possibly within a few weeks, said Anthony S. Fauci.

“We’re looking over our shoulder at omicron,” Fauci, President Joe Biden’s chief medical adviser for Covid-19, said at a U.S. Chamber of Commerce Foundation event. The latest variant of concern, which scientists in South Africa first identified around Thanksgiving, will start to dominate in the U.S. “I would imagine within a period of a few weeks as we go into January,” he said.

The delta variant remains the main source of infections in the U.S., accounting for 96% of cases, Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Wednesday during a White House press briefing. That means delta is largely responsible for the latest surge to 117,900 cases per day. Cases were down to less than 60,000 per day back in July.

“Delta is still a serious problem,” Fauci said. With the uptick of delta-related infections, the country getting into “the depths of winter,” and “with omicron breathing down our back, things could get really bad, particularly for the unvaccinated.”

But he said that those who are vaccinated and boosted will be relatively well protected against severe disease.

The omicron variant represents about 3% of the cases in the U.S, but it has a doubling time of about three days. By comparison, the delta variant doubled at a rate of about two weeks.

“It is the most transmissible virus of Covid-19 that we’ve had to deal with thus far,” Fauci, who’s also the director of the National Institute of Allergy and Infectious Diseases, said about omicron.

South Africa has already been overtaken with the variant and the U.K. also expects the omicron variant to dominate soon. “If things go in the United States the way they’ve gone in other countries—and there’s no reason to believe that that won’t be the case—it will soon become dominant here,” he said.


MACs to Send Direct Mailing to Hospices Regarding MA VBID Hospice Component Model

From the National Association for Home Care and Hospice (NAHC)

In January 2021, the Centers for Medicare & Medicaid Services (CMS) initiated a four-year demonstration model (the MA VBID Hospice Component) under which eligible Medicare Advantage (MA) plans are permitted to offer hospice services as part of the benefit packages. For calendar year (CY) 2022, the MA VBID Hospice Component will expand such that plans in 22 states and territories will participate in the model in some areas of each state. In order to ensure that plans appropriately pay hospices serving patients enrolled in a participating plan and that plans are properly paid by CMS for those patients, special billing rules apply to hospices serving patients in the model.

In an effort to raise general awareness of the MA VBID Hospice Component model and to provide education on participation and billing for MA enrollees that receive hospice services in affected areas, CMS recently issued Change Request 12524/Transmittal 11160 – Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, Value-Based Insurance Design (VBID) Model, Medicare Advantage Organizations (MAOs), directing the Medicare Administrative Contractors (MACs) to conduct a direct mailing to all hospice providers in their jurisdictions affected by the service areas identified for the CY2022 MA VBID Hospice Component [Including Colorado]

According to the transmittal, CMS requires participating MA organizations to communicate with hospice providers in the service area of their participating plans. Hospice providers are also encouraged to communicate with MA plans regarding any questions about the model, billing, coverage, and enrollment. Hospice providers must submit claims and notices to participating MA plans to receive payment when their enrollees elect to receive hospice care. Hospice providers must submit claims and notices to their Medicare contractor, as well, for informational purposes. Enrollees of participating MA plans may seek hospice care with any Medicare-certified hospice provider.

In addition to this specific direct outreach, the MACs have also been directed to conduct education for hospice providers about the CY2022 MA VBID Hospice Benefit Component through relevant outreach events, listserv messages and web postings, which shall include information about CMS and MAC educational products and resources about the model.


HHS Announces Critical Investments to Implement Upcoming 988 Dialing Code for National Suicide Prevention Lifeline

Dear all,

Today [December 20, 2021] the Department of Health and Human Services, through its Substance Abuse and Mental Health Services Administration (SAMHSA), will make critical investments in suicide prevention and crisis care services, announcing $282 million to help transition the National Suicide Prevention Lifeline from its current 10-digit number to a three-digit dialing code – 988.
In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. Converting to this easy-to-remember, three-digit number will strengthen and expand the existing Lifeline network, providing the public with easier access to life-saving services. The Lifeline currently helps thousands of people overcome crisis situations every day. The 988 dialing code will be available nationally for call, text or chat beginning in July 2022.
Standing up the 988 dialing code is a key part of the Biden-Harris Administration’s focus on ensuring that those in crisis have someone to call, someone to respond, and somewhere to go. The 988 code is a first step toward transforming crisis care in this country, creating a universal entry point to needed crisis services in line with access to other emergency medical services.
“As we continue to confront the impact of the pandemic, investing in this critical tool is key to protecting the health and wellbeing of countless Americans – and saving lives. Giving the states a tool to prevent suicide and support people in crisis is essential to our HHS mission of protecting the health and wellbeing of everyone in our nation,” said HHS Secretary Xavier Becerra. “We know that remembering a three-digit number beats a ten-digit number any day, particularly in times of crisis, and I encourage every state to rev up planning to implement 988 for the sake of saving lives.”

For more information, please see the materials below:

Lily Griego
Regional Director
U.S. Department of Human Services


FDA Authorizes First Oral Antiviral for Treatment of COVID-19

Comagine Health

The Food and Drug Administration  issued an emergency-use authorization Dec. 22 for the first oral antiviral treatment for mild to moderate COVID-19 in adults and children over 12.

Pfizer's Paxlovid will be available by prescription only and should be initiated as soon as possible after the diagnosis of COVID-19 and within five days of symptom onset, according to a press release from the FDA. The pill is designed for those who are high risk for progression to severe COVID-19, including hospitalization or death.

“Today’s authorization introduces the first treatment for COVID-19 that is in the form of a pill that is taken orally — a major step forward in the fight against this global pandemic,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research.  

Paxlovid is not a substitute for vaccination in those for whom COVID-19 vaccination and a booster dose are recommended, the FDA states. 

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