AHIP 2019 Value-Based Care: The Future of Healthcare

On September 24th-26th, America’s Health Insurance Plans (AHIP) hosted the National Conferences on Medicare, Medicaid, and Dual Eligibles in Washington, DC.  I had the pleasure of attending the conference on that Tuesday. It’s an annual opportunity for medical groups and health insurance providers to identify ways they can successfully collaborate to improve both individual and population health.

In Tuesday morning sessions we heard from some of the industry’s top thought leaders from both the public and private sectors on issues surrounding the growing role of technology and patient engagement in the Medicare space. Value-Based Care continues to receive bi-partisan support; Arrah Tabe-Bedward Deputy Director, Center for Medicare and Medicaid Innovation (CMMI) Centers for Medicare & Medicaid Services (CMS) encouraged advanced payment model adoption across payers to accelerate use of risk-sharing models. Several sessions focused on leveraging technology to enhance the Medicare beneficiary experience, such as phone apps for members to access their healthcare data and obtain information on quality/cost. There was an agreement that there needs to be a bi-directional sharing of data between health plans and providers, with a focus on transparency and usability of data. However, technology can add a layer of complexity in the delivery of care in the provider/payer collaboration. Providers don’t want to add another portal log-in, so intelligence needs to be integrated into the provider workflow, whereby there is insight sharing from the health plans instead of simply data sharing at the point of care. Technology, more specifically artificial intelligence, will play an integral part in distilling and prioritizing the information.

The afternoon sessions focused on the integration across the Medicare and Medicaid programs, evaluating topics such as the state of integration, policy updates, and persistent challenges. Tim Engelhardt, Director Federal Coordinated Health Care Office, Centers for Medicare and Medicaid Services (CMS) reviewed the current MMCO initiatives, including the new D-SNP (Dual Eligible Special Needs Plans) regulations and integration requirements. The subsequent sessions focused on the practical and policy implications of the new regulations, D-SNP integration requirements, MMPs operations, and state coordination issues. Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans that limit enrollment to people eligible for both Medicare and Medicaid, known as Dual Eligibles. The Bipartisan Budget Act of 2018 outlined the minimum responsibilities for D-SNPs to coordinate Medicaid benefits, requirements for integrating Medicare and Medicaid appeals and duty to notify state Medicaid programs of hospital admissions. The below slide outlines the requirements and attributes of HIDE-SNPs and FIDE-SNPs:

Melanie Bella, Chief of New Business and Policy Cityblock Health, closed the National Conference on Dual Eligibles by outlining five challenges in this space:

  1. There is a tension between the State vs. Federal programs– who should be in charge?
  2. There are Continuity of Care issues for Dual Eligibles due to coordination of benefits, which causes challenges for both patients and providers
  3. The current models are medicalized, however, dual eligibles non-medical services for issues related to social determinates of health
  4. There are payment challenges related to state and federal contributions
  5. There are enrollment mechanisms challenges due to the divide between the Medicare and Medicaid programs

Seema Verma, Administrator Centers for Medicare & Medicaid Services (CMS) closed the National Conference on Medicare with a few thoughts that apply to both the Medicare and Medicaid space. She indicated that government intervention leads to less innovation, increased costs, and increased taxes, adamantly criticizing the Medicare for All proposal. Her view is that patients should have the opportunity to pick high value providers and we need price transparency and quality transparency. Regardless of which side of the political spectrum you fall, the adoption and continuous development of a value-based system where private industry and government partner together is “the future of healthcare.”

I’m always motivated and energized to hear from key industry stakeholders on their innovations in value-based care, and ways that we can work together to advance the patient experience. The National Medicare and Medicaid conference pointed out that we have a long way to go, but I’m hopeful we can make some meaningful progress over the next year. Hope to see you there next year!

Maria Nikol

About the Author


Maria Nikol

Maria Nikol is a senior business consultant with 10 years of experience in healthcare operations and healthcare strategy. Her specialization includes process improvement and the application of emerging models of healthcare delivery such as Patient-Centered Medical Homes and Accountable Care Organizations. She holds a Master of Jurisprudence in Health Law from Widener University and a Bachelor of Science in Pharmaceutical Marketing and Management from the University of the Sciences in Philadelphia.

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