This Week in Managed Care: July 6, 2018

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This week, the top managed care stories included a federal judge blocking Kentucky’s Medicaid work requirements; CMS announced it would launch a demonstration to encourage Medicare Advantage providers to take on more risk; and researchers identify racial disparities in HIV incidence and recommended a 5-part plan of action.


Kentucky’s Medicaid work requirements are blocked, CMS launches a demonstration to encourage Medicare Advantage providers to take on more risk, and researchers recommend a plan of action to address disparities in HIV incidence.

Welcome to This Week in Managed Care, I’m Laura Joszt.

Kentucky's Medicaid Work Requirements Blocked

A federal judge blocked Kentucky’s Medicaid waiver, which required many beneficiaries to be working, volunteering, or training for a job in order to get coverage. The judge ruled that the approval of the plan had been “arbitrary and capricious” since CMS had not considered if the plan would actually help the state provide medical assistance to its citizens.

CMS Administrator Seema Verma criticized the decision, saying: “Today’s decision is disappointing. States are the laboratories of democracy and numerous administrations have looked to them to develop and test reforms that have advanced the objectives of the Medicaid program. The Trump administration is no different. We are conferring with the Department of Justice to chart a path forward.”

Following the judge’s decision, Kentucky’s governor, Republican Matt Bevin, announced he was cutting Medicaid dental and vision benefits for nearly half a million enrollees.

Bevin had indicated months earlier that if Kentucky’s work requirements were blocked, he would take steps to dismantle the state’s Medicaid program. He even signed an executive order protecting the work requirements that stated if a lawsuit was brought against the requirements and a judge ruled in the plaintiffs’ favor, the state would start the process of terminating Medicaid expansion.

Waiving MIPS for MA Participants

CMS is looking to launch a demonstration of the Medicare Advantage Qualifying Arrangement Incentive, which would waive requirements under the Merit-based Incentive Payment System, known as MIPS, for doctors who opt into the new program.

The demonstration aims to put Medicare Advantage (MA) on a more equal playing field with fee-for-service Medicare. Currently, physicians who participate in advanced alternative payment models in Medicare Advantage plans are still subject to MIPS requirements.

Earlier in June, a collection of 11 health groups had sent a letter urging HHS to recognize physician participation in MA toward participation criteria for the Advanced APM Model track of the Medicare Access and CHIP Reauthorization Act.

They wrote: “If we are truly committed to moving our nation’s delivery system away from volume-based compensation and towards payment for value and high-quality care, we must ensure provider incentives are aligned in both traditional Medicare and MA to incent participation in risk-bearing alternative payment models.”

Racial Disparities in HIV Incidence

While there have been recent drops in HIV diagnoses across the United States, African Americans are still disproportionately affected by the virus compared with whites.

Researchers observed that while African Americans represent 12% of the US population, they accounted for 43% of all HIV cases in the United States in 2014 and 44% of new diagnoses in 2016.

In addition, the trends have been worsening. In 2016, African Americans were 8.4 times more likely to be diagnosed with HIV than whites, up from 7.9 times more likely, indicating that the disparity continues to grow.

The research team recommended a 5-part plan that community leaders and other stakeholders can implement to address disparities:

  • Immerse: Be out and active in African American communities and participate in free or reduced cost testing.
  • Be nonjudgmental: Work to eliminate prejudices and unconscious biases in treating patients.
  • Be knowledgeable: Understand new approaches to treatment, nuances in medications, and other issues related to HIV/AIDS.
  • Advocate: Speak out and call attention to the epidemic and its impact on the African American community. Recruit other advocates in the effort.
  • Innovate: Society must continue to be proactive and create solutions that evolve with the times and the changing needs of the affected populations.

For more, visit

OCM Webcast

Finally, if you missed the live broadcast of Implementing Alternative Payment Models for Improved Population Health: Experiences From the OCM, you can now watch it online.

During the webcast, Bruce Feinberg, DO; Bruce Gould, MD; and Mark Liu discussed how Northwest Georgia Oncology Centers and Mount Sinai Health System handled the requirements of the Oncology Care Model, their take on recent updates to the model, and what additional changes they would still like to see.

Watch the full discussion.

For all of us from the Managed Markets News Network, I’m Laura Joszt.

Thanks for joining us.