Tag: Contracting Workgroup

Each year the Centers for Medicare and Medicaid Services (CMS) reviews payment practices and policy changes under fee-for-service, or traditional, Medicare. The CY2024 PFS included important coding and payment changes for services to address health-related social needs (HRSNs) through separate payments for Community Health Integration (CHI), SDOH Risk Assessment, and Principal Illness Navigation (PIN) services.

In July 2024, CMS released its annual draft proposed updates for next year’s rules (CY2025 Medicare Physician Fee Schedule), which includes a request for information (RFI) regarding barriers to implementation for services to address HRSNs. 

The draft rule also includes proposed updates to:

• Caregiver Training Services;
• ACO quality measures re: screening for HRSNs; and
• the Advanced Primary Care Model (APCM)

All of these proposed changes could affect services to address HRSNs. 

On September 9, 20204 the Partnership submitted two letters to CMS on behalf of Partnership Co-Chairs and undersigned organizations. Sixty-five organizations signed on to the response to the request for information (RFI) regarding current barriers to implementing services to address HRSNs (CHI/PIN). Fifty-three organizations signed on to the letter regarding changes needed and proposed updates for telehealth, caregiver training services, ACO quality measures, and the Advanced Primary Care Model. Agency officials will review and document the more than 12,000 comments submitted as they finalize the rule.

Stay tuned for updates once we see the final rule published—likely in early November 2024. We will also be in touch with stakeholders regarding implementation resources that we plan to create and promote
once we see the final rule.

The Partnership to Align Social Care and Camden Coalition hosted our eighth Coffee and Contracts session focused on compliance and risk management. Jennifer Raymond, Chief Strategy Officer at AgeSpan, and Mark Humowiecki, General Counsel & Senior Director of National Initiatives at Camden Coalition, shared their organizations' journeys with compliance and discussed what their compliance committees looks like, the policies and procedures in place, and how they meet healthcare standards. Participants broke into groups for facilitated discussions to learn from their peers about compliance and risk management.

Link to recording

Meeting Slides (PDF)

Resource: Compliance Checklist (excel sheet)

Meeting summary and notes (pending)

Each year the Centers for Medicare and Medicaid Services (CMS) reviews payment practices and policy changes under fee-for-service, or traditional, Medicare. The CY2024 PFS included important coding and payment changes for services to address health-related social needs (HRSNs) through separate payments for Community Health Integration (CHI), SDOH Risk Assessment, and Principal Illness Navigation (PIN) services.

In July 2024, CMS released its annual draft proposed updates for next year’s rules (CY2025 Medicare Physician Fee Schedule), which includes a request for information (RFI) regarding barriers to implementation for services to address HRSNs. 

The draft rule also includes proposed updates to:

• Caregiver Training Services;
• ACO quality measures re: screening for HRSNs; and
• the Advanced Primary Care Model (APCM)

All of these proposed changes could affect services to address HRSNs. 

SIGN-ON REQUEST:
Please consider joining the Partnership to Align Social Care Co-Chairs and other organizational stakeholders on TWO sign-on letters offering comments. You may sign on to one or both letters: 

1. Sign-on letter responding to the RFI re: barriers to implementing services to address HRSNs
2. Sign-on letter responding changes needed and proposed updates for telehealth, caregiver training services, ACO quality measures, and the Advanced Primary Care Model

We also encourage you to download template language covering all of these issues and incorporate as applicable into your organization's response . As a reminder, comments are due by 5:00 p.m. ET on September 9, 2024, and can be submitted online.  

RESOURCES:

• SIGN-ON Letters (combined) responding to CMS CY2025 PFS Proposed Rule (pdf)
• Template language provided by the Partnership (Word version available for download)
• CMS CY2025 PFS Proposed Rule: https://www.regulations.gov/document/CMS-2024-0256-0045 
• Additional information and resources from the Partnership about this proposed rule: https://www.partnership2asc.org/implementation-resources/ and Resources List

USAging’s Aging and Disability Business Institute has released valuable resources from the 2023 CBO-Health Care Contracting Survey. Explore the data brief from their research partner Scripps Gerontology Center and the infographic and toolkit slides to gain essential insights for your organization on health care contracting. https://bit.ly/4dF0LYr

The Partnership to Align Social Care and Camden Coalition hosted our seventh Coffee and Contracts session that focused on the process of vetting social care contracts from a CCH perspective. Ester Sefilyan, VP Network Services, and Anne Ly, MPH, Senior Director of Network Contracts & Systems Management, at Partners in Care Foundation discussed how their organization uses contract templates, the relationship between the CCH operations staff and the contracting officer, and how their team works with outside legal counsel. Participants broke into groups for facilitated discussions to learn from their peers about vetting social care contracts.

Link to recording

Meeting Slides (PDF)

Resource: Partners in Care Foundation Contract Terms worksheet (pdf)

Meeting summary and notes (pending)

The session focused on data sharing experiences from health plan, CBO, and CCH partnerships. Jolene Tanner, Senior Director of Health and Social Programs at United Healthcare, and Amy Fynmore, Housing and Health Program Manager at United Health Group, provided an overview of various data sharing arrangements including through community investment and direct vendor relationships. Attendees also had the opportunity to break into moderated group discussions with their peers.

Link to Recording

Meeting Slides (PDF)

Meeting Summary and Notes (PDF)

This session focused on what to expect from negotiations with a health plan when developing a contracted partnership. Nikki Kmicinski, Executive Director at Western New York Integrated Care Collaborative, Inc., shared her experiences in negotiating with healthcare organizations and discussed strategies to achieve a mutually beneficial contract for both parties. Attendees also had the opportunity to break into moderated group discussions with their peers.

Link to Recording

Meeting slides (PDF)

Meeting Summary and Notes

Join the Partnership to Align Social Care and Camden Coalition for a monthly peer learning series that provides an opportunity for presenters and participants to go deeper into specific topics related to contracting between CBOs/CCHs and healthcare organizations.

Sessions will allow participants to:

• Participate in peer-to-peer learning about contracting between CBOs, CCHs, and healthcare organizations;
• Learn about and engage with stakeholders and leaders of the Partnership to Align Social Care;
• Find opportunities to support new CCHs and get involved in ongoing national initiatives;
  Generate new learning which can be packaged into future resources and leading practices.

Register for the series and learn more at www.partnership2asc.org/coffee-and-contracts!

The recording and materials are available for the February 27, 2024 Partnership to Align Social Care event, Meeting the Administration’s Call-to-Action: Leading Practices to Address Health-Related Social Needs in Communities Across the Nation, featuring a discussion with officials from the U.S. Department of Health and Human Services (HHS) and key community and health care leaders on opportunities to address health-related social needs (HRSNs) through community partnerships.

Healthcare entities and social services providers are increasingly recognizing the importance of partnerships among historically siloed sectors to address health-related social needs (HRSNs). While the number of community-based organizations (CBOs) and community care hubs (CCHs) pursuing contracting relationships with healthcare organizations is increasing, CBOs and CCHs can experience challenges entering into contracting arrangements with the healthcare sector.

The Partnership to Align Social Care, the Aging and Disability Business Institute, and Camden Coalition created a Healthcare Guide to Contracting with CBOs. This toolkit offers a deep dive into leading contracting practices to effectively and efficiently address HRSNs. Each module focuses on the essential elements of contracting between health care and community partners and features leading practices from the field.

Healthcare entities and social services providers are increasingly recognizing the importance of partnerships among historically siloed sectors to address health-related social needs (HRSNs). While the number of community-based organizations (CBOs) and community care hubs (CCHs) pursuing contracting relationships with healthcare organizations is increasing, CBOs and CCHs can experience challenges entering into contracting arrangements with the healthcare sector.

Join the Partnership to Align Social Care, the Aging and Disability Business Institute, and Camden Coalition for a webinar series offering a deep dive into leading contracting practices to effectively and efficiently address HRSNs. In each webinar, we will focus on the essential elements of contracting between health care and community partners and feature leading practices from the field. Each event will also highlight key findings from a four-part toolkit, Healthcare Guide to Contracting with CBOs, developed with extensive input from CBOs, health plans, and health systems. While these resources were developed for a healthcare audience, CBOs, CCHs, and other health and social care ecosystem stakeholders will benefit from understanding how healthcare organizations approach the contracting process.

Attendees will gain:

• Guidance on designing a payment structure/model that aligns contracting parties around shared goals and produces value for each party (Oct. 10 @ 2 ET);
• Recommendations on how to develop an effective Scope of Work, based on insights from healthcare organizations and CBOs with extensive cross-sector contracting experience (Nov. 14 @ Noon ET);
• Insight on how payers can improve collaboration with CBOs and strategies to anticipate, avoid, and respond to common challenges that arise when CBOs, CCHs, and payers set out to work together (Dec. 12 @ Noon ET); and
• Perspective from CBO and healthcare leaders highlighting leading practices from community and health care partners that have effectively contracted to address HRSNs for multiple populations.

Registrants will receive access to all three webinars. All registrants will receive the recordings and follow-up resources. Register here: https://us06web.zoom.us/webinar/register/WN_GInAyGusSbSsqe0985JjAA