The Blog to Transform Advanced Care

Advancing Care through Innovation, Observation and Collaboration.

President-elect Joe Biden has tapped Dr. Marcella Nunez-Smith, an expert on health care inequality, to help lead the transition’s coronavirus advisory board. That puts the fight against the virus’ disproportionate impact on Black, Latino and Native American communities smack in the center of the new administration’s pandemic response. The selection of Nunez-Smith, a Yale researcher who was born in the U.S. Virgin Islands, for such a visible post reflects how the incoming administration is trying to make good on campaign promises to elevate action on addressing health inequity, especially in the context of the public health emergency response.

C-TAC is encouraged by Biden’s focus on our country’s most vulnerable populations. For more information, see the POLITICO article here.

Other Updates:

Primary Care First Participants Announced

The Center for Medicaid and Medicaid Innovation (CMMI) announced on Friday, Nov. 11 details on the first cohort of Primary Care First participants, including the 916 primary care practices and 37 regional partnerships with commercial, State, and Medicare Advantage plans partnering across the selected demonstration regions. This cohort reflects practices that will be participating in the model’s “General” track, and does not specify which practices will be involved in the Seriously Ill Population (SIP) track or the General-SIP “Hybrid” track. Information on SIP participation is expected in the coming weeks. Primary Care First is a voluntary, five-year alternative payment model that will reward value and quality by offering innovative payment model structures to support delivery of advanced primary care. The Primary Care First “General” Model Option will begin on Jan. 1, 2021, and the SIP option is slated to begin on April 1, 2021.

Please monitor the Primary Care First webpage for future model updates. Please contact PrimaryCareApply@telligen.com with any questions or comments.

Trump Administration Announces Two New Rules to Address High Medication Costs

The Trump Administration has announced two new rules related to the high cost of medications. The first, Most Favored Nations (MFN), finally implements the MFN Model which will test more closely aligning payment for Medicare Part B drugs with international prices and removing incentives to use higher-cost drugs. The goal is to control the unsustainable growth in Medicare Part B spending without adversely affecting quality of care for beneficiaries. The 7-year model will be national and affect a set of 50 Medicare Part B drugs that encompass a high percentage of Medicare Part B drug spending. Comments are due in later January and C-TAC will review the rule for its pertinence to those living with serious illness and comment accordingly.

The second rule, the Rebate Rule, changes the use of prescription drug rebates negotiated by health plans, pharmacy benefit managers, and pharmaceutical manufacturers to require the use of rebates to lower prescription drug prices for individuals at the point-of-sale, rather than to lower premiums for all plan beneficiaries. This rule is final and there is therefore no comment period for it. It may be challenged in the courts and C-TAC will monitor its status and update members as needed.  

CMS Releases Factsheet on State Medicaid Participation in CHART Model

On Friday, Nov. 19, CMS released a fact sheet providing guidance to state Medicaid agencies (SMAs) on the Community Health Access and Rural Transformation (CHART) model. The CHART model focuses on addressing disparities in access to care in rural communities by encouraging innovation in care delivery systems. The Community Transformation Track of the model is one where communities receive upfront funding and participating hospitals receive financial flexibility through a Capitated Payment Amount (CPA). In practice, SMAs will enter into payment arrangements with participating hospitals to implement this model.

SMAs are required to participate as an Aligned Payor and as an Advisory Council member in the model. Optionally, they may choose to act as the Lead Organization in the Community Transformation Track of the model. This would entail forming the Advisory Council, recruiting providers, developing and implementing the Transformation Plan, and overseeing the implementation of the alternative payment model (APM).

The pre-implementation period of the model begins in July 2021 and the first performance period is slated to begin in July 2022. More information on the CHART model can be found here.

Nursing Homes See Continued Record Number Of New COVID-19 Cases

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released a report on Monday showing nursing homes in the U.S. continue to see a record number of weekly new cases this month due to the community spread among the general population, surpassing previous peaks since the Centers for Medicare & Medicaid Services (CMS) started tracking cases in nursing homes. Recent data released by Johns Hopkins University and the Centers for Medicare & Medicaid Services (CMS) show that with the recent spike in new COVID cases in the general U.S. population, weekly nursing home cases are also on the rise. According to Johns Hopkins University, weekly new COVID cases in the general U.S. population rose by 229 percent to 796,761 new cases the week of Nov. 8. A correlating uptick in new cases in nursing homes occurred when cases in the surrounding community started rising back in mid-September.

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