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CMS Releases Updated Look at COVID-19’s Impact on the Medicare Population

The Centers for Medicare & Medicaid Services (CMS) recently released a snapshot of the impact COVID-19 has had on the Medicare population. The monthly update, released June 30, shows there were more than 4.3 million COVID-19 cases among the Medicare population and more than 1.2 million COVID-19 hospitalizations.

Data in the snapshot covers the period January 1, 2020, to April 24, 2021.

A factsheet and additional information can be fund at https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot.

Econometrica Ready for New CMS Priorities Under Brooks-LaSure

Chiquita Brooks-LaSure was sworn in as Administrator of the Centers for Medicare & Medicaid Services (CMS) on May 27, 2021. With any change in administration, new priorities take precedence.

Akin Gump of Strause Hauer & Feld LLP wrote a primer prior to her confirmation hearings on some of the priorities CMS will pursue under Brooks-LaSure, including healthcare coverage expansion, health equity, surprise billing, and healthcare financing.

These priorities match Brooks-LaSure’s career in the public and private sectors. She was intimately involved in the writing of and implementation of the Patient Protection and Affordable Care Act (ACA), first as a staffer for the U.S. House Committee on Ways and Means and then for CMS’ Center for Consumer Information and Insurance Oversight (CCIIO). She has also worked to improve access, quality, and efficiency in healthcare, and she consulted on healthcare financing and cost transparency.

Econometrica has worked with CMS for more than two decades and looks forward to continuing this partnership under Brooks-LaSure.

Source: CMS

CMS
Chiquita Brooks-LaSure – Administrator of the Centers for Medicare & Medicaid Services (CMS)

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.

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

Opioid Use Disorder and the Medicare/Medicaid Population

Opioid Use Disorder and the Medicare/Medicaid Population

BETHESDA, MD – The United States has long been engulfed in an opioid epidemic that stemmed from increased prescribing of opioids in the 1990s and is characterized today by use of synthetic opioids, like fentanyl, as well as illicit opioids such as heroin.[1] By 2017, there were 58 opioid prescriptions written for every 100 Americans.[2] This rise in opioid use has led to an increased prevalence of Opioid Use Disorder (OUD) in a variety of populations.

OUD—which may involve the misuse of prescribed opioid medications, diverted opioid medications, or illicitly obtained heroin—is typically a chronic, relapsing illness associated with significant rates of morbidity and mortality.[3] The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, describes OUD as a “pattern of opioid use leading to problems or distress,” with at least two of the following occurring within a 12-month period:[4]

  1. Taking larger amounts or taking drugs over a longer period than intended.
  2. Persistent desire or unsuccessful effort to cut down or control opioid use.
  3. Spending a great deal of time obtaining or using the opioid or recovering from its effects.
  4. Craving, or a strong desire or urge to use opioids.
  5. Problems fulfilling obligations at work, school, or home.
  6. Continued opioid use despite having recurring social or interpersonal problems.
  7. Giving up or reducing activities because of opioid use.
  8. Using opioids in physically hazardous situations.
  9. Continued opioid use despite ongoing physical or psychological problems likely to have been caused or worsened by opioids.
  10. Increased tolerance (i.e., need for increased amounts, or diminished effect with continued use of the same amount).
  11. Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

Although OUD is similar to other substance use disorders, there are many unique features, including risk of physical dependence in as little as 4 to 8 weeks and severe symptoms such as chills, cramps, vomiting, and insomnia during withdrawal.[3] Despite its unique features, the factors contributing to OUD are very general and can include ease of access, environmental and genetic factors, social support system, addictivity of the drug, and early use.

Looking at the rate of opioid prescribing among Medicare and Medicaid beneficiaries can help us gain an understanding of the development of OUD in America. In 2018, the Centers for Medicare & Medicaid Services (CMS) analyzed the prevalence of OUD among beneficiaries and reported that 6 out of every 1,000 Medicare beneficiaries and 8.7 of every 1,000 Medicaid beneficiaries suffer from OUD.[5] Using data from 2006 to 2015, another CMS study found that 23.5 percent of dual-eligible beneficiaries in 2015 had a substance use disorder.[6] For the Medicaid-only population, there were 31 million opioid claims in 2017, and opioid prescriptions represented 4.57 percent of all Medicaid prescription claims.[7] One year earlier, in 2016, 14.4 million of the 43.6 million Medicare-only beneficiaries enrolled in Part D received opioids.[8]

The national data for OUD and opioid prescriptions is presented here to provide the foundation for a larger discussion around OUD in the United States. Over the course of this series of newsletters, we will dive into topics such as OUD treatment options, how COVID-19 is impacting treatment centers across the country, and much more. To read more of our OUD coverage, please click here. 

[1] Centers for Disease Control and Prevention (CDC). (2020). Opioid overdose: Understanding the epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html.

[2] CDC. (2020). Opioid overdose: Prescribing practices. Retrieved from https://www.cdc.gov/drugoverdose/data/prescribing/ prescribing-practices.html.

[3] Strain, E. (2020). Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. UpToDate. Retrieved from https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis.

[4] American Psychiatric Association. (2018). Opioid use disorder. Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder.

[5] CMS. (2018, June 11). CMS opioids roadmap. CMS.gov Blog. Retrieved from https://www.cms.gov/blog/cms-opioids-roadmap.

[6] Anderson, K. K., Hendrick, F., & McClair, V. (2018, October). Data analysis brief: National trends in high-dose chronic opioid utilization among dually eligible and Medicare-only beneficiaries (2006-2015). Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/DataStatisticalResources/Downloads/OpioidsDataBrief_2006-2015_10242018.pdf.

[7] CMS. (2019). Medicaid State Opioid Prescribing Mapping Tool. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/OpioidMap_Medicaid_State.

[8] Office of Inspector General. (2017, July). Opioids in Medicare Part D: Concerns about extreme use and questionable prescribing [OEI-02-17-00250]. U.S. Department of Health & Human Services. Retrieved from https://oig.hhs.gov/oei/reports/oei-02-17-00250.pdf.

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.

Opioid Use Disorder (OUD)—which may involve the misuse of prescribed opioid medications, diverted opioid medications, or illicitly obtained heroin—is typically a chronic, relapsing illness associated with significant rates of morbidity and mortality.

Press Contact

Jonathan Fusfield