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2 posts from February 2020

02/20/2020

Archway Health's Keely Macmillan Discusses Medicare Bundled Payment Performance (February 19th)

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CMS' efforts, via the Centers for Medicare and Medicaid Innovation (CMMI),  to develop episode-based bundled payment models in Medicare is now it its eight year.  This work is currently being pursued under the 2018-initiated Bundled Payments for Care Improvement (BPCI) Advanced (that succeeded the BPCI demo, begun in 2013, now concluded) and the Comprehensive Care for Joint Replacement (CJR) and the Oncology Care Model demonstrations, both began in 2016.   These models are designed to pay a specified or target price for a discrete episode of care, in CJR for a hip or knee replacement.   Assuming quality performance is met, if spending is below the target price the provider recoups the savings, if above the target they owe the difference.   Recent evaluations, discussed here, show these programs are on balance demonstrating savings, though modest, to the Medicare program.  Listeners may recall I interviewed Archway's Founder and CEO, Dave Terry two years ago this  month.     

During this 37 minute interview (lengthy but worth it), Ms. Macmillan begins by providing an overview of Archway Health.  She then discusses Archway's results to date regarding participation in BPCI Advanced relative to financial performance, quality and utilization - that she unpacks by discussing what accounts for savings, what quality is being measured and how measuring quality can be improved and steps CMS is taking to more accurately target price episode payments via peer groupings.  We discuss CMS' latest evaluation of the agency's CJR demonstration and other evaluation findings, participation by MA and commercial plans in episode based bundled payment arrangements, how best these demonstrations or models can be evolved, i.e., how better episode and population-based models can be better integrated, the inclusion of Part D spending, whether bundled payments should be made mandatory and what explains Archway's success in participating in these payment  models.      

Ms. Keely Macmillan is currently Senior Vice President of Policy and Solutions management at Archway Health where she oversees all aspects of Archway’s involvement CMS' Keely+MacmillanBundled Payments for Care Improvement (BPCI) Advanced demonstration.   She is an expert in alternative payment models including bundled payments and ACOs, value-based purchasing, and MACRA’s Quality Payment Program.  Previously, Ms. Macmillan was manager of government payment policy at Partners HealthCare, the largest health system in Massachusetts, where she managed public payer financial forecasting and led the government payment policy team in the analysis of performance-based reimbursement models.   Ms. Macmillan earned her master’s degree in Health Policy and Management from the Harvard T.H. Chan School of Public Health and a Bachelor of Science from Yale University.

Information on Archway Health is at: https://www.archwayhealth.com/.

Mentioned during this discussion:

CMS' January 2020 8-page overview of episode based bundled payment results to date is at: https://innovation.cms.gov/Files/reports/episode-payment-models-wp.pdf

The Lewin Group's second CJR evaluation published last June is at: https://innovation.cms.gov/Files/reports/cjr-secondannrpt.pdf.

Evaluations of BPCI published in the January issue of Health Affairs are by Amol Navathe, et al. and Rajender Agarwal, et al., are at: https://www.healthaffairs.org/toc/hlthaff/39/1 (subscription is required).

02/11/2020

Andrea Rodgers Discusses the Recent 9th Circuit Court Decision in Juliana v the US (February 10th)

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This past January 17 the 9th Circuit Court of Appeals ruled in Juliana v the US.   Filed in 2015 by 21 children and others, the plaintiffs argued health harm caused by the federal government’s long support or promotion of the fossil fuel industry violates their Constitutional right to life and liberty, i.e., their right to a survivable climate.  The plaintiffs argued further the court should redress this harm by issuing an injunction requiring the federal government  to prepare a plan for judicial review and approval that would draw down green house gas emissions.  In its defense the federal government argued there is no fundamental constitutional right to a stable climate system, or that the state of the climate has no connection to personal life and liberty.  The court ruled 2-1 in favor of the US government, arguing the plaintiffs complaint was not redressable or was nonjusticiable, despite admitting "climate change was occurring at an increasingly rapid pace," "will wreak havoc on the Earth if left unchecked" and "may hasten an environmental apocalypse."  The dissent argued the Constitution's perpetuity principle, that life and liberty is secured for both ourselves and posterity, does not "condone the Nation's willful destruction."  

During this 30 minute discussion, Ms. Rodgers begins by describing the physical and mental health harm experienced by the Juliana plaintiffs.  She notes organizations that contributed amicus briefs.  She explains the majority opinion's reasoning (authored by Justice Andrew Hurwitz) that ruled in favor of the defense and the minority opinion authored by Justice Josephine Staton.  She discusses media coverage of the case, related cases, moreover the December Urgenda decision by the Supreme Court of the Netherlands that ruled in favor of the plaintiffs, and the Juliana plaintiffs intent to appeal the January decision or petition the 9th Circuit Court for a rehearing en banc.   

Ms. Andrea Rodgers is Senior Litigator Attorney at Our Children’s Trust, an Oregon-based public interest law firm, that represents the Juliana plaintiffs.  In her role at Our Children's Trust she also is lead counsel on the constitutional youth climate lawsuits against the state of Washington, Aji v. State of Washington, and the state of Florida, Reynolds v. State of AndreaFlorida.  Previously, Ms. Rodgers served as an Honors Attorney for the U.S. Department of Transportation, In-House Legal Counsel for the Snoqualmie Indian Tribe, and Staff Attorney for the Western Environmental Law Center.  After graduation from the University of California, Santa Barbara in 1998 and the Arizona State University School of Law in 2001, where she served as co-executive editor of Jurimetrics: The Journal of Law, Science and Technology, she clerked for the Hon. John C. Gemmill on the Arizona Court of Appeals.  In 2016, Seattle Met Magazine recognized her legal work representing youth in the Washington climate change case in King County Superior Court against the Washington Department of Ecology (Foster v. Ecology).  

The 9th Circuit Court's January decision is at: http://cdn.ca9.uscourts.gov/datastore/opinions/2020/01/17/18-36082.pdf

For complete information on the Juliana case go to: https://www.ourchildrenstrust.org/juliana-v-us

Information on the Urgenda case decided this past December in the Netherlands is at: https://www.urgenda.nl/en/themas/climate-case/