Learning to focus on empathy while addressing critical healthcare issues.
During the 2023 Michigan Association of Health Plans (MAHP) Summer Conference, amidst discussions about the challenges impacting the industry, one theme echoed throughout: the indispensable role of empathy.
From healthcare professionals to the members they serve, the prevailing sentiment was to confront these obstacles head-on while nurturing an environment of diversity, equity, and inclusion (DEI). By doing so, Michigan not only seeks to navigate existing challenges but also aims to build a future where healthcare is transformative and all-encompassing.
Advancing Healthcare Access and Affordability with Healthier Michigan Plan
Attendees were focused on creating a healthier Michigan for all.
The recent enactment of the Healthier Michigan plan built upon the success of the Healthy Michigan Plan (HMP). By introducing program improvements, the plan promotes healthier outcomes for enrollees.
The Healthier Michigan plan includes changes to cost-sharing requirements, including:
- Removing cost-sharing requirements for enrollees, securing their access to necessary care
- Shifting administrative focus towards addressing Social Determinants of Health (SDoH) and promoting health equity, moving away from copay-centric approaches
The new plan introduces impactful improvements to the Health Behaviors Incentive Program, encouraging health plans to promote healthy behaviors for enrollees. Key modernizations include:
- Providing a broader range of options for completing the HRA
- Offering enrollees the choice to participate in healthy behavior motivational interviewing or coaching
- Requiring MDHHS to share completed HRAs with health plans promptly
- Establishing a formal process for health plans to submit new wellness programs
- Removing the disqualification of insurance for enrollees who fail to fill out their HRA
- Eliminating cost-sharing requirements for enrollees
The Healthier Michigan plan represents a decisive step towards advancing healthcare access and affordability in the state.
Enhancing Coordination for Dual-Eligible Enrollees
In a session led by Sarah Rosenblum, Director at ATI Advisory, and Lindsay Barnette, Director at the Medicare-Medicaid Coordination Office, their discussion centered around supporting dual-eligible enrollees as they transition towards a more “Medicare Advantage-like” offering.
The current separate eligibility requirements, benefits, and rules for Medicare and Medicaid contribute to a fragmented and disjointed system for dual eligibles. In response to these challenges, policymakers have designed various coverage arrangements aimed at improving the coordination of Medicare and Medicaid services.
A significant step in Michigan’s approach involves the transition of enrollees in Medicaid Plans (MMP) to Integrated Special Needs Plans. However, this transition is a complex undertaking and is expected to take several years to complete. Entities and MCOs will play a pivotal role in this transformative process.
Rosenblum and Barnette stressed that much is to be accomplished before transitioning enrollees. Awards are projected to be granted in 2025, and the go-live date is set for January 2026.
Understanding Health Policy Shifts: Insights from CMS Deputy Group Director
Raymond J. Swisher, Deputy Group Director, of Drug and Health Plan Operations at CMS, delved into the current state of national MA (Medicare Advantage), Marketplace, and MMP programs.
A standout point of interest in the discussion was Michigan’s becoming the leading state in MA, with 59% of its population enrolled in MA plans. This significant percentage surpasses the average rate of 50% across the country, underscoring the popularity and importance of the MA program in Michigan.
Additional discussions about the future of the state’s ACA Marketplace were featured during multiple panels.
The main draw was the bipartisan momentum towards a Michigan State-Based Exchange (SBE). A bill addressing this transition is already in place, awaiting further review and debate when the legislatures return to session in the Fall. Despite the advantages of moving to an SBE, one of the major points of contention revolves around Michigan’s higher user fee.
The conference also delved into the significance of Enhanced Direct Enrollment (EDE) as a provision for SBE success. EDE’s implementation holds potential benefits for streamlining the enrollment process and enhancing the user experience.
With the potential of the SBE transition being sent to the Governor next spring, Michigan’s ACA Marketplace may witness transformative changes that could positively impact access and affordability.
Advancing Health Equity through 1115 Waivers and Value-Based Payments
States have underutilized paths to promote health equity through innovation.
Mindy Lipson, MPH, Director of Manatt Health, spoke to the potential of 1115 waivers, their impact on state Medicaid programs, and how progressive states are utilizing them.
47 states currently have an 1115 waiver in place, offering alternative approaches to Medicaid enrollment that suit the needs of state residents. However, a pivotal aspect to note is that any request made under the 1115 waiver must be budget neutral.
To effectively tackle health equity, the session emphasized the importance of adopting a multi-faceted approach, encompassing:
- Improved data collection and analysis
- An understanding of the root causes of disparities
- Increased capacity to current workforce capacity
- Expanded health literacy initiatives
- Increased accessibility to healthcare services for all
The discussion featured two states whose recent initiatives promote health equity through Value-Based Payments programs. Arizona provides incentives for ambulatory and community-based healthcare providers, encouraging them to focus on delivering equitable and quality care. Additionally, Massachusetts has allocated substantial funding to hospital incentives and creating domains to measure success, including a robust quality component.
By leveraging the power of 1115 waivers and Value-Based Payments, states can drive innovation, improve healthcare accessibility, and bridge health disparities, ultimately fostering a more equitable and inclusive healthcare landscape for all citizens.
If you have any questions or would like to discuss the topics covered at VAHP, feel free to reach out to the author of this recap, Marc Bryant, at Mbryant@softheon.com.