Mass General Brigham required to implement a cost-savings plan

Posted on by • Posted in Cost Management, Cost Reduction, Health Policy, Health System, Hospital, Hospital Industry, Performance Evaluation, Performance Improvement, Performance Management • Leave a comment

https://www.healthcarefinancenews.com/news/mass-general-brigham-required-implement-cost-savings-plan

The Massachusetts Health Policy Commission has unanimously voted to hold Mass General Brigham accountable for its spending and is requiring the health system to develop and implement a performance improvement plan that will result in cost-saving reforms. 

The proposed performance improvement plan must contain specific cost-reducing action steps, savings goals, process and outcome metrics, timetables, and supporting evidence, among other requirements. 

MGB has 45 days to file the proposed performance improvement plan with the HPC, request a waiver from the requirement, or request an extension of the filing deadline. 

From 2014 to 2019, MGB had a larger, cumulative commercial spending in excess of the benchmark than any other provider, totaling $293 million, the HPC said. MGB’s ongoing cost-control strategies have not reduced its commercial spending growth to below-benchmark rates, the HPC Board said.

MGB is seeking to spend nearly $2.3 billion in Massachusetts on expansions and improvements at two of its hospitals and on the creation of three new ambulatory sites in the communities of Westborough, Westwood, and Woburn, Massachusetts. 

“Mass General Brigham has a spending problem,” HPC Chair Dr. Stuart Altman said by statement. “Its spending performance and plan for new expansions at their flagship hospitals and into the Boston suburbs raise significant concerns, as documented by the HPC today.”

The HPC’s analyses found that these expansions would increase commercial healthcare spending by at least $46 million to $90.1 million and translate into higher commercial insurance premiums for Massachusetts residents, families and businesses.

The HPC also said this would impact healthcare access and equity as care shifts to MGB providers from other providers in Massachusetts. Other providers are anticipated to lose $153 million to $261 million in commercial revenue each year. These other providers have fewer financial resources and lower average prices for commercially insured patients and they generally serve larger proportions of MassHealth patients and communities with higher social needs than MGB, HPC said.

Based on these findings, the HPC concluded these expansions are inconsistent with the Commonwealth’s healthcare cost containment goals.

The HPC’s Board took separate action, voting unanimously to issue a public comment detailing its analyses of the three expansion proposals currently under review by the Massachusetts Department of Public Health Determination of Need Program. 

WHY THIS MATTERS

MGB includes two academic medical centers and is the largest and generally highest-priced system in the Commonwealth, HPC said. 

The HPC’s findings and conclusions stand in contrast to those of Independent Cost Analyses that were conducted by a third-party vendor and released on December 28, 2021, which conclude that all three projects are consistent with the Commonwealth’s cost containment goals. 

The December cost analysis, part of the determination of need process, projected those three sites would result in a “small overall decrease” in healthcare spending, MGB said, according to WGBH. Its proposed suburban locations would give its existing patients a lower-cost option than hospital care and save them a drive into Boston, the report said.

“Today’s comments by the Health Policy Commission ignore this state’s crippling healthcare capacity crisis — which preceded the pandemic, as well as the fact that patients deserve the choice to access high quality care, closer to their homes, at a lower cost,” MGB said, according to the report.

THE LARGER TREND

Massachusetts established the Health Policy Commission in 2012 as an independent government agency to lead collective efforts to make healthcare more affordable for residents.

This is the first performance improvement plan to be required from a provider or health plan by the HPC. 

Program of All-Inclusive Care for the Elderly(“PACE”)

Posted on by • Posted in Alternative Payment Model, Community-Based Services, Health Policy, Program of All-Inclusive Care for the Elderly (“PACE”), Value-Based Healthcare • Leave a comment

Click to access Industry_Insights_1.26.22.pdf

What is PACE? - SeniorAdvisor.com Blog

While the ongoing pandemic has impacted all Americans, Covid has been most detrimental to the elderly and people with disabilities, many of whom depend on long-term services and supports (LTSS). This has
placed greater emphasis on alternative care models that allow elderly Americans with
LTSS needs to live at home, where a vast majority of this population prefers to receive
care. Today, more than 800,000 people are on waitlists to receive home and community-based services. This transition of care to the home is a theme that has become prevalent during Covid and warrants attention going forward.

Additionally, value-based care has emerged as a fixture of the healthcare landscape.
More than a trend, this secular theme has brought with it a proliferation of new
companies. While value-based care has different meanings depending on application,
the core concept is that all stakeholders win. Members receive better care, payers see
cost savings and providers are less encumbered with administrative work, allowing them
to be more engaged with members. Value-based care underscores the concept that the
best outcomes are achieved when all stakeholders are aligned.

One of these models that inherently encompasses value-based care AND offers an
alternative LTSS model that is home and community-based is the Program of All-Inclusive Care for the Elderly (“PACE”). PACE is a fully integrated, highly coordinated
care model that provides comprehensive medical and social services to frail, medically
complex, elderly individuals, most of whom are dually eligible for Medicare and Medicaid
benefits. PACE addresses the social determinants of health – transportation, meals, and
social isolation, to name a few. 95% of PACE participants live safely in the community.
PACE is a fully capitated model, which allows providers to deliver all services
participants need, rather than limit them to those reimbursable under Medicare and
Medicaid fee-for-service plans.

PACE produces tangible outcomes for all stakeholders:

 Members experience reduced hospital admissions, decreased rehospitalizations,
reduced ER visits, fewer nursing home admissions and better preventive care;

 States pay PACE programs 13% less than the cost of other Medicaid services;
 Seniors receive better quality outcomes and can remain living in their communities; and importantly
 97.5% of family caregivers would recommend PACE to someone in a similar situation.

The PACE model is roughly 50 years old, and in recent years enrollment has grown at a healthy 9% CAGR. Yet, while there are approximately 58,000 PACE participants, there are ~2 million Americans that could qualify, representing a penetration rate of just 3%. This is low. There are many reasons for this: regulation and policy challenges, limited access to the program, lack of awareness of the program by seniors, and capital-intensity to develop.

In Cain Brothers’ view, as we look to emerge from this pandemic, PACE is well positioned for an acceleration. There are a number of factors we have been watching that support this:


The current administration is pushing to expand home and community-based services. In April 2021, Senator Bob Casey (D-PA), Chairman of the Special Committee on Aging, introduced the PACE Plus Act that would strengthen and expand access to the PACE program;


 The existing PACE landscape remains very fragmented and many players would benefit from scale and
innovation;


 Over the last few years, more private investment has come into the sector, which should help to fuel growth and expansion; and


 More state Medicaid programs are planning for or are in the process of (most recently, DC and Illinois) developing and expanding PACE programs creating an opportunity for new entrants.


How might the PACE landscape change over the next few years? We could see consolidation of current players, new entrants, or partnerships between not-for-profits and for-profits. Whatever the form, PACE clearly benefits all stakeholders. The pandemic has cast a light on this value proposition and carved a path for adoption to meaningfully accelerate.

COVID-19 deaths pass peak from delta surge

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Omicron Variant, Health System, Hospital, Hospital Industry, Hospitalizations, Mortality, Pandemic, Public Health, Public Health Infrastructure, Public Health Strategy, Public Opinion, Public Perception, Unvaccinated, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy • Leave a comment

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Welcome to Wednesday’s Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. Subscribe here: thehill.com/newsletter-signup. 

Masks come to the Super Bowl: Fans attending the big game next month will be given KN95 masks.  

Despite omicron being less severe on average, the sheer number of cases has driven deaths past the peak from last year’s delta surge.  

The average number of U.S. COVID-19 deaths this week surpassed the height of the delta surge earlier this fall and is at its highest point since last winter, when the nation was coming out of the peak winter surge. 

The seven-day average of deaths hit 2,166 on Monday, according to the latest data from the Centers for Disease Control and Prevention (CDC). Average daily deaths in mid-September before the omicron variant was discovered peaked at around 1,900. 

While increasing evidence shows omicron may be less likely to cause death or serious illness than delta, the sheer infectiousness and the speed at which it spreads has overwhelmed hospitals, primarily with people who have not been vaccinated. 

The U.S. saw the highest numbers of deaths in the pandemic just over a year ago, before vaccines were widely available, when the daily average reached 3,400. The last time the U.S. topped 2,000 deaths was last February, as the country was slowly coming down from the January peak. 

Caution urged: Infections are falling in states that were hardest hit earlier, as well as broadly across the nation. Hospitalizations are also falling, but deaths are a lagging indicator and are still increasing. CDC Director Rochelle Walsenky said deaths have increased about 21 percent over the past week. 

The fact that the omicron variant tends to cause less severe disease on average also helped avoid an even greater crisis that would have occurred if it was as severe as the delta variant.  

Long COVID-19: Study author explains four factors that can predict how you get it

Posted on by • Posted in Clinical Research, Coronavirus, Coronavirus Delta Variant, Coronavirus Long-Term Complications, Coronavirus Mutation, Coronavirus Omicron Variant, Coronavirus Treatment, Long COVID, Pandemic, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy • Leave a comment

https://thehill.com/policy/healthcare/591528-long-covid-study-author-explains-four-factors-that-can-predict-how-you-get?userid=12325

Long COVID-19: Study author explains four factors that can predict how you get it | KFOR.com Oklahoma City

Long COVID-19 has had an air of mystery around it for months. Doctors have struggled to explain or understand why some people who contract COVID-19 end up having lingering symptoms like fatigue, difficulty thinking clearly, or shortness of breath weeks or even months later.  

A new study published in the journal Cell helps shed some light on the condition, for the first time identifying four factors that can help predict whether someone will develop long COVID-19.  

“Being able to identify the factors that can cause the disease, cause the chronic condition, is the first step towards defining that it actually is a condition that can be treatable,” Jim Heath, president of the Institute for Systems Biology in Seattle, and an author of the study, said in an interview. “And then some of these factors also are in fact the kind of things one can imagine developing treatments for.” 

The most important factor the study identified in predicting long COVID-19 is the presence of certain kinds of antibodies called autoantibodies, which mistakenly attack healthy parts of the body. Autoantibodies are associated with autoimmune diseases, like lupus, where your immune system attacks your own body.  

But someone does not have to have an autoimmune disease to have autoantibodies present and be at higher risk for long COVID-19, Heath said.  

“Most people that have autoantibodies don’t really know it,” he said. “They’re what you call subclinical … maybe you have a risk of some autoimmune disease but it hasn’t developed.” 

Still, he said one practical application of the study is that lupus treatments could be “worth exploring” as treatments for long COVID-19.  

The second factor that can lead to long COVID-19 is the reactivation of a different virus called Epstein-Barr Virus (EBV), which is extremely common, infecting up to 90 percent of people at some point, and often causes only mild symptoms. 

The virus usually becomes inactive in the body following the initial infection, but it can be reactivated when someone gets COVID-19, helping lead to long COVID-19 symptoms.  

Heath said EBV could become reactivated when the immune system is distracted by fighting COVID-19.  

“It could be that the large distraction that’s COVID-19 infection is taking that attention away,” he said.  

The third factor identified is how much of the virus that causes COVID-19, officially called SARS-Cov-2, is present in the blood, known as the “viral load.” 

This factor along with the role of EBV suggests that new antiviral drugs that fight the immediate effects of COVID-19 infection, like the Pfizer pill Paxlovid, might also be useful in treating long COVID-19.  

“Two of these predictive factors are virus levels that are in the blood,” Heath said. “So that suggests that these antivirals that are being used to treat acute disease probably have a role for long COVID as well.” 

The final of the four factors that can predict long COVID-19 is more easily identifiable: if a patient has Type 2 diabetes.  

While these four factors are a step forward in understanding what causes long COVID-19 and helping develop treatments, the mechanism for why they are associated with long COVID-19 is still not fully clear.  

“They have a flavor of mechanistic factors,” Heath said. “The actual mechanism is not clear.” 

The study followed 309 COVID-19 patients, taking blood and swab samples at different points in time.  

In addition, one way to likely cut the risk of long COVID-19 is vaccination. A separate study from the United Kingdom found that vaccinated people were 41 percent less likely to develop long COVID-19.