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CMS’ New Case Study Showcases Successful Community Advisory Board Collaboration

The Centers for Medicare & Medicaid Services (CMS) released a case study highlighting Health Net of West Michigan, an organization participating in CMS’ Accountable Health Communities (AHC) Model. The AHC Model seeks to identify if healthcare costs and utilization can be impacted by the identification and subsequent mitigation of Medicare and Medicaid beneficiaries’ health-specific social needs. One part of Health Net’s approach to this identification is through its advisory board, which consists of community partners across multiple sectors and “focuses on addressing social determinants of health at the community and systems levels.”

The inclusion of community members on an advisory board can sometimes prove a struggle. As advisory boards do not have formal authority to direct change, participants can feel disheartened and superfluous to the process. Health Net seeks to engage its community advisory board members by putting them first: From letting the advisory board select their own role titles (“community advisor” was ultimately chosen) to helping advisors develop their professional skills and find opportunities that utilize their lived experiences, Health Net recognizes that by gaining their advisors’ trust and proving their commitment to the community, they will foster goodwill and find advisors with legitimate interest in bettering the community. The case study includes a quote from a community advisor, showcasing how Health Net’s approach to the community has resulted in engaged advisors who understand their role on the board and responsibility to their neighbors:

Health Net’s advisory board has proven beneficial for both the organization and the community at large. The community advisors bring their lived experiences to the table, ensuring that staff members recognize the humanity of those affected by the policies and challenges identified. Community advisors also ensure that Health Net’s actions are aligned with the needs and desires of the community at large, and can offer suggestions and ideas on how to “make [programs] more culturally sensitive and user friendly,” which further aids Health Net in fostering goodwill within the community.

“It’s important to me to decrease disparities about who gets help and who doesn’t […] I give them the idea of what it’s like to be a client out here… They always listen to what I have to say and support whatever I mentioned.” 

—Community Advisor

The CMS case study in full can be accessed at https://innovation.cms.gov/media/document/ahcm-casestudy-healthnet.

Health Net’s advisory board has proven beneficial for both the organization and the community at large. The community advisors bring their lived experiences to the table, ensuring that staff members recognize the humanity of those affected by the policies and challenges identified.

The State Data Resource Center’s Recommendations to Support Vaccine Equity

BETHESDA, MD – As of April 26, 29 percent of the U.S. population is fully vaccinated. Vaccines are now available to all U.S. adults, and 2.6 million doses are being administered in the United States every day. As vaccination rates continue to increase, it is important that vaccine distribution is monitored to ensure that vulnerable populations are reached. Ensuring equitable access to the COVID-19 vaccine—recognized as a national priority by the Centers for Disease Control and Prevention (CDC) —requires that data are available and appropriately used to evaluate socioeconomic and demographic vaccine distribution trends.

Earlier this month, the State Data Resource Center (SDRC) released information to support states in identifying COVID-19 vaccination Medicare claims among their dually eligible beneficiaries. SDRC was established by the Centers for Medicare & Medicaid Services (CMS) in 2011 to help states obtain dually eligible beneficiary data. Econometrica supports CMS in providing resources to states to assist in requesting and using Medicare data files for care coordination and program integrity purposes.

The COVID-19 vaccine information was posted as an announcement on the SDRC website, developed and operated by Econometrica, and includes a recommended process for identifying COVID-19 vaccine claims in both the Coordination of Benefits Agreement (eCOBA) file and the monthly Parts A and B dataset. In both files, Healthcare Common Procedure Coding System (HCPCS) codes are used to identify COVID-19 vaccine claims. Pfizer, Moderna, AstraZeneca, and Johnson & Johnson each have their own assigned HCPCS codes with additional vaccine administration codes that specify whether the claim was the individual’s first or second dose.

In addition to identifying COVID-19 vaccine claims and ensuring each beneficiary received the appropriate number of doses, SDRC recommends that states link these claims to the beneficiary’s demographic information. In doing so, disparities in vaccine uptake across race/ethnicity, disability status, or geography can be evaluated and addressed.

The SDRC announcement highlights an important opportunity for state Medicaid agencies. Analyses, made possible through the use of SDRC data and the SDRC support team, can help to inform policy. By identifying any racial, ethnic, or socioeconomic disparities in access to COVID-19 vaccines, state policymakers can shift their distribution plans to ensure vaccines are available to vulnerable, dually eligible beneficiaries.

Vaccines are now available to all U.S. adults, and 2.6 million doses are being administered in the United States every day.

Econometrica Explores ESRD Treatments From the Patient Perspective

Econometrica Explores ESRD Treatments From the Patient Perspective

BETHESDA, MDEconometrica released a new issue brief exploring treatment options for end-stage renal disease (ESRD) and their problems from the patient perspective. In partnership with LMI and the American Association of Kidney Patients, the ESRD Brief: Patient Perspectives discusses dialysis treatments and kidney transplantation and highlights the implications for patients of the ESRD Treatment Choices (ETC) Model. The ETC Model, rolled out by the Centers for Medicare & Medicaid Services, aims to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD.

ESRD Brief: Patient Perspectives

The Problem From the Patient Perspective

Press Contact

Jonathan Fusfield

CMS Updates Data Snapshot Showing COVID’s Impact on Beneficiaries

BETHESDA, MD – The Centers for Medicare & Medicaid Services recently released an updated data snapshot detailing the impact of the COVID-19 pandemic on Medicare beneficiaries. Among the findings:

  • Medicare fee-for-service spending associated with COVID hospitalizations rose to $10.3 billion.
  • The rate of cases in rural areas (4,271 per 100,000) outpaced those in urban areas (4,151 per 100,000) for the first time.
  • The pandemic continues to hit certain populations harder than others, including American Indian/Alaska Native beneficiaries (2,393 per 100,000), African-American beneficiaries (1,937 per 100,000), and Hispanic beneficiaries (1,617 per 100,000).

“Although the snapshot data suggests COVID-19 continues to impact certain populations disproportionately, it also points to the importance of COVID-19 vaccines and other opportunities for prevention and treatment in disadvantaged groups.”

The snapshot includes data for services provided from January 1, 2020, to December 26, 2020.

More information can be found here: https://www.cms.gov/newsroom/press-releases/cms-updates-medicare-covid-19-data-snapshot.

The pandemic continues to hit certain populations harder than others, including American Indian/Alaska Native beneficiaries, African-American beneficiaries, and Hispanic beneficiaries.

Clinical Practice Team Adds to Econometrica’s Capabilities

Clinical Practice Team Adds to Econometrica’s Capabilities

BETHESDA, MD – Econometrica has formed a dedicated Clinical Practice Team consisting of healthcare professionals from a variety of healthcare disciplines. The addition of this team augments the technical capabilities of Econometrica’s Health Group to provide expertise in training, information diffusion, health research, quality measure development, monitoring, evaluation, technical assistance, and data analytics.

The team will be led by Dr. Kristie McNealy and includes a geriatric nurse practitioner and two registered nurses with clinical experience spanning primary care, acute care, hospice, home health, and rehabilitation settings.

The Clinical Practice Team provides clinical and health operations insights to a range of Econometrica’s projects, including supporting the Centers for Medicare & Medicaid Services (CMS) in selecting clinically relevant quality measures for the Bundled Payments for Care Improvement Advanced model and developing training content around patient assessment and coding for nurses and quality staff working in post-acute care settings. Team members also provide valuable perspective on the challenges providers face in delivering and coordinating care in different settings and the barriers beneficiaries experience attempting to access the care they need.

“The Clinical Practice Team will continue to support our various healthcare projects as well as allow Econometrica to support new projects in the areas of medical records abstraction, electronic health records, and clinical consultation,” President/CEO Cyrus Baghelai said. “We look forward to offering our clients and partners these expanded services.”

With healthcare and related industry trends constantly evolving, Econometrica’s experts use a variety of research and evaluation methods to provide innovative approaches for each client. In recent years, our Health Group, has developed tailored technical assistance plans for CMS, including working with States in accessing and using CMS data sources under the State Data Resource Center contract; has had more than 250,000 provider impacts based on trainings focused on understanding and complying with the IMPACT Act on the Post-Acute Care Training contracts; and has had 3 quality measures endorsed by the National Quality Forum under our Programs of All-Inclusive Care for the Elderly contract.

About Econometrica:

Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers, and business development.

With healthcare and related industry trends constantly evolving, Econometrica’s experts use a variety of research and evaluation methods to provide innovative approaches for each client.

Press Contact

Jonathan Fusfield