self-funded employer

CMMI Focuses on Behavioral Health

Practice area:

The Shift to Value Based Reimbursement Needs to Address Behavioral Health Access and Costs

CMS recently announced that the Center for Medicare and Medicaid Innovation (CMMI) is interested in lowering the cost of care for Medicare and Medicaid beneficiaries with behavioral health conditions while improving the quality of care and the overall access to care for those patients, and will convene a public meeting in the fall to discuss ideas to accomplish these goals. Notably, CMMI indicated that such a model may include participation by other payers, qualify as an Advanced Alternative Payment Model, improve health care provider participation in telehealth services, and address the needs of beneficiaries with care deficiencies in certain areas that lead to poor clinical outcomes or potentially avoidable expenditures, such as substance use disorders, mental disorders with comorbidities, Alzheimer’s disease, and/or behavioral health workforce challenges.  As we deal with an aging population and continue to confront the reality that clinical interventions account for only a small part of managing

Repealing-Replacing the Affordable Care Act: Considerations for Employers with Self-Funded Plans 

Practice area:

Over the last several years we have seen employers, especially those with self-funded health plans, evolve in their approach to wellness programs.   Programs have grown from gathering data – e.g., steps on a pedometer, answers to a health risk assessment – to using the information gathered to take a data driven approach to plan design for health plans and their stand alone or integrated wellness programs.  We have also seen employers roll out their wellness programs to spouses, which is a positive trend especially given the latest NIH study which suggests a link between parental obesity and developmental delays in children.  Low hanging fruit, such as targeting more hands on care management for high risk, high cost participants, identifying and implementing mechanisms to promote step therapy and generic drug spend, and removing barriers to managing chronic conditions such as $0 copays for maintenance prescriptions and lower cost office visits, have all been part of our self-funded employers’ toolkits over these past few years as the