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Aligning quality improvement is a key principle of the Special Needs Plan Alliance and its member health plans. One health plan that has been working toward such alignment in an innovative way for several years is Senior Whole Health, part of the Magellan system, located in Massachusetts. Recently, Deborah Paone sat down with Andrew McClure of Senior Whole Health, a Magellan company, to discuss his work around aligning quality measurement and improvement. Andrew also presented this information at the Special Needs Plan Alliance Executive Forum in October 2018. This blog post offers insight from Andrew on what they did and what drove the success of this partnership between medical group providers and this special needs health plan.
On February 9, 2018, Congress passed and the President signed into law the Bipartisan Budget Act of 2018. Title III of this legislation contained a series of landmark provisions for advancing the integration of Medicare and Medicaid and for improving care for persons with complex chronic conditions. In this post, Rich Bringewatt, President and CEO of the National Health Policy Group describes the implications of this new law.
This interactive online discussion, moderated by Kedar Mate, MD, Chief Innovation and Education Officer at the Institute for Healthcare Improvement, provided opportunities to share ideas and ask questions about how to make the finances work for complex care.
When individuals participate in both Medicare and Medicaid, it would be ideal for them to be enrolled in one plan that integrates both programs and coordinates the benefits. And in some cases, this is already happening. But too often, these individuals—who are already highly vulnerable—are enrolled in entirely different, uncoordinated plans for each program. This further complicates an already fragmented delivery system for this high-needs group.

We all know that the emergency department is the simplest, most relaxed place in a hospital. Given this, it should be easy to treat and refer patients with substance abuse disorder, right? Of course not!

In fact, it’s so complex that I have yet to find any U.S. hospital that allows patients to be identified, treated, and transferred with any degree of consistency and predictability. But it can be done.

The Keystone ACO is a partnership between Geisinger, Evangelical Community Hospital, Wayne Memorial Hospital, and the Wright Center for Graduate Medical Education. It serves 73,000 Medicare beneficiaries in the Medicare Shared Savings Program (MSSP). Keystone ACO’s beneficiaries include residents of 41 primarily rural Pennsylvania counties as well as parts of New York, New Jersey and Maryland.
One of the most pervasive challenges in our health care system is allowing people to optimize their independence and continue living at home as they age and develop more complex health and social needs. These individuals often need long-term services and supports (LTSS), and their number is increasing. It’s estimated that the population of Americans in need of LTSS will rise to 27 million by 2050.

By David Blumenthal, MD, MPP, President, The Commonwealth Fund, and Tanya Shah, MBA, MPH, Assistant Vice President, Delivery System Reform, The Commonwealth Fund

The dialogue on caring for patients with complex needs has moved beyond a recognition that social factors like housing or nutrition have an outsize impact on health to practicalities. Now, health care providers are asking: what can we actually do to help?

Caring for the complex chronically ill — a population that makes up about 5 percent of patients and nearly 50 percent of health care spending — is remarkably challenging. It’s also essential, as the United States transitions to a health care system that is driven by value.

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