CMS aims to modernize Medicaid with focus on SUD

Medicaid has an outdated payment model compared to private payers, but the Centers for Medicare and Medicaid Services (CMS) aims to fix that. Technical and financial resources are now available for states under the new Medicaid Innovation Accelerator Program (IAP).

The goal is to improve care and reduce costs by driving payment and service-delivery reform that will ultimately put Medicaid capabilities  more in line with private-payer capabilities. The IAP builds on recommendations from states, the National Governors Association and the National Association of Medicaid Directors. One concern repeatedly identified by states is the growing need to address substance use disorder (SUD). CMS issued an informational bulletin on July 11 that outlines single-state efforts to improve SUD among Medicaid populations, which might be replicable in other states.

According to CMS, states report overall challenges in innovating because of a lack of resources to integrate and evaluate data; a lack of consistent and endorsed metrics that are appropriate for the Medicaid population; and a lack of deep coordination among federal entities.

Among other goals, the IAP will:

·         Identify and advance new models for better SUD care;

·         Support data analytics, including real-time data to identify those with SUD or at-risk;

·         Support alignment and integration of quality measurement for SUD outcomes; and

·         Drive timely dissemination of best practices.

CMS has already begun separate state innovation programs. For example, the state of Washington tackled substance abuse and emergency department (ED) usage by adopting best practices. As a result, ED visits decreased by 9.9 percent; the number of people with frequent ED use dropped by 10.7 percent; and the number of visits resulting in narcotic prescription dropped by 24 percent. The state attributed savings of about $34 million.¹

Over the next few weeks, CMS will be holding interactive sessions to gather input from states, consumers and experts. If you have suggestions, you may email mailto:MedicaidIAP@cms.hhs.gov.

Reference:

1 Best practices were: track ED visits to avoid ED “shopping”; implement patient education; institute an extensive case management program; reduce inappropriate ED visits by collaborative use of prompt visits to primary care physicians; implement narcotic guidelines to discourage narcotic-seeking behavior; track data on patients prescribed controlled substances; and track progress of the overall plan to make sure steps are working. Washington State Health Care Authority, Report to the Legislature: Emergency Department Utilization: Update on Assumed Savings from Best Practices Implementation, March 20, 2014. At https://www.hca.wa.gov/Documents/EmergencyDeptUtilization.pdf