The March 28th Healthcare Delivery Transformation conference kicked off with MA-RI HFMA President Garrett Gillespie welcoming members and guests. He spoke about the new Healthcare Delivery Transformation committee that formed over the past year and developed this program. He also reviewed our chapter’s social media presence and upcoming events. Before passing the microphone off to the next speaker, he thanked the program coordinators: Kimberly Carlozzi, Karen Granoff, Gary Janko, Krista Katsapetses, and Roger Price.
The first speaker of the day was Alex Calcagno, Director of Federal and Community Relations for the Massachusetts Medical Society. In her annual “View from the Capitol” update she reviewed the major healthcare issues up for debate in the 116th session of Congress and set the stage for the upcoming presidential election. Calcagno broke down the demographics of the newly elected class in Congress with a focus on the diversity of freshman members with respect to age, gender, sexual orientation, and race.
Calcagno provided a detailed walkthrough of the current ACA debate and the “cataclysmic” implications of an unlikely potential repeal. Calcagno also reviewed a number of different options proposed for “Medicare for All” from a buy-in option to the complete elimination of insurance companies. Calcagno shared thoughts on current action around the cost of prescription drugs which may be addressed during this session through the passage of the CREATES act. Calcagno also expects Congress to address “surprise bills” this session with three options on the table: arbitration, tying the payment to Medicare, or leaving it up to individual states to determine. Other issues currently receiving legislative attention include opioids (both prescribing and treatment), gun violence (closing loopholes and allowing the federal government to conduct research into gun violence), and social determinants of health (specifically medically tailored meals with Community Servings). The Massachusetts Medical Society has taken a stance opposing the federal “gag rule” and many insurance initiatives including association health plans. They are in support of movement around interoperability of EMRs, though they are concerned about patient privacy. Calcagno closed by reviewing the Massachusetts legislators who hold leadership positions with respect to healthcare and then opened the conversation up for questions.
Next up was a panel on “New Trends in Practice Management and Patient Care” moderated by Steven Defossez, MD, the Vice President of Clinical Integration for the Massachusetts Health and Hospital Association. The panelists included Eileen Fingerman, MD, the Clinical Director at Ibis Health Services and a faculty member at Maine Dartmouth in Geriatric Medicine, Amy Flaster, MD, the Associate Medical Director for Population Health at Partners HealthCare, and Randi Sokol, MD, MPH, an Assistant Professor and the Director of Faculty Development and the Pain/Addiction Curriculum at Tufts Family Medicine Residency Program and Cambridge Health Alliance.
Dr. Fingerman provided an overview of the challenges in taking care of geriatric patients, particularly as patients strive to remain living independently. Her target population is dual eligible patients who are both on MaineCare and Medicare. Ibis Health leverages high patient engagement through “coaches” who serve as health managers and touch screen technology that is easily accessible even for patients with limited to no prior computer skills. Dr. Sokol focuses her practice on opioid addiction. She spoke about addiction as a chronic disease, not a one-time issue and how her practice leverages group visits with 5-15 patients at a time. She has found this approach to have a high success with patients, increased physician productivity, and reduced clinic costs. Dr. Flaster spoke about the Partners Health Care Integrated Care Management Program (iCMP) focused on high risk and medically complex patients specifically including those with patients covered by payer risk contracts.
As a panel, the team spoke about Medicare reimbursement for Chronic Care Management (CCM) including the patient co-pay (which is not applicable for dual eligible and those with MediGap coverage). The panel also discussed how they have address patient demand for programs, struggles with medication reconciliation across providers, managing patients in the emergency room, discharging patients (if applicable) from programs, and the overall challenges of program management.
After a short break, Josh Mast, a Senior Regulatory Strategist for Cerner presented on an “Introduction and Foundation in Value Based Care.” After opening with a reminder of the growing healthcare spend in the United States versus patient outcomes compared to our peers Mast reviewed a number of different models for payment under value based care. He walked through a timeline of different incentive based programs and discussed the goals, guidelines, and unintended consequences of programs. Most Medicare APM can be divided into three groups: Accountable Care Organizations (ACOs), Medical Home Models, and Bundled Payments or Episodic Care Models. Mast dove into interoperability requirements for both this year and changes for next year, state based Medicaid Section 1115 Waivers, and state based Patient Centered Medical Homes, and state ACOs. Mast concluded some thoughts on where we will go from here. He cited an HFMA study from 2017 highlighting a number of barriers to the success of these programs (regulatory uncertainty, resourcing, interoperability, etc.) as well as the increased focus on social determinants of health.
After a break for lunch we enjoyed learning about a topic not normally covered at an HFMA conference: marijuana. After a few jokes about the “cookies at the dessert table,” Howard Brick, a Strategic Advisor for Future Farm Technologies provided an overview of the cannabis industry. Brick reviewed the differences among cannabis products, some of the emerging research on potential medical benefits of products, the related legal situation, and the anticipated growth of both the medical and recreational marijuana market. He closed his presentation with a review of some of the challenges the industry continues to face despite state by state legislative changes including access to investments and banking services.
The final panel of the day covered Accountable Care Organizations and the lessons learned looking back after one year. Nancy Turnbull, Senior Associate Dean for Professional Education, Harvard T. H. Chan School of Public Health moderated the panel with Alastair Bell, MD, Executive Vice President, Strategy and Chief Operating Officer at Boston Medical Center Health System, Ipek Demirsoy, Chief of Payment and Care Delivery Innovation for MassHealth, Deborah Morales, Program Director at Rhode Island Medicaid Accountable Entities, and Jean Yang, President of Tufts Health Public Plans.
Demirsoy spoke of the 17 ACOs in Massachusetts since March of 2018 as well as the Community Partners “sister program” to ACOs. The first priority was ensuring members had a smooth transition as some members had a change in care provider. She has been pleased with the community engagement in the ACOs and some of the innovation she has seen. Data and operations continue to remain a challenge. Morales provided background on the reinvention of Medicaid in Rhode Island that began in 2015 with the goal of moving away from volume based payments and towards population health through the Accountable Entity (AE) program. Currently Rhode Island has six certified AEs. Morales spoke to the challenges of member engagement as most individuals know they are enrolled in a health plan but do not know they are in a specific AE.
Dr. Bell spoke about ACO reform as a direct connection between the health system and the state where issues felt at the state quickly “trickle down” to the provider. He also discussed the opportunity provided by the designated “dollars to invest” which must be closely tracked to ensure they are used only for approved expenses. He sees current key challenges including setting budgets for the ACOs, managing risk adjustments related to the social determinants of health, and health plan/provider relationships. Yang spoke about her confidence in the ACO model. From a health plan perspective, she sees the organizational mandate on all sides dedicated to making the system work. Yang sees a challenges regarding future funding once the five year federal funding ends as well as in how to engage patients with the health plan.
The day ended with a raffle for Red Sox tickets provided by PwC and gift cards provided by HealthLeads.