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Use of Recommended Health Care Measures to Prevent Selected Complications of Sickle Cell Anemia in Children and Adolescents — Selected U.S. States, 2019

Author/s: 
Schieve, L. A., Simmons, G. M., Payne, A. B., Abe, K., Hsu, L. L., Hulihan, M., Pope, S., Rhie, S., Dupervil, B., Hooper, W. C.

Introduction: Sickle cell disease (SCD), a group of inherited blood cell disorders that primarily affects Black or African American persons, is associated with severe complications and a >20-year reduction in life expectancy. In 2014, an expert panel convened by the National Heart, Lung, and Blood Institute issued recommendations to prevent or reduce complications in children and adolescents with the most severe SCD subtypes, known as sickle cell anemia (SCA); recommendations included 1) annual screening of children and adolescents aged 2–16 years with transcranial Doppler (TCD) ultrasound to identify those at risk for stroke and 2) offering hydroxyurea therapy to children and adolescents aged ≥9 months to reduce the risk for several life-threatening complications.

Methods: Data from the IBM MarketScan Multi-State Medicaid Database were analyzed. TCD screening and hydroxyurea use were examined for 3,352 children and adolescents with SCA aged 2–16 years and continuously enrolled in Medicaid during 2019. Percentage change during 2014–2019 and variation by health subgroups were assessed. Analyses were stratified by age.

Results: During 2014–2019, TCD screening increased 27% among children and adolescents aged 10–16 years; hydroxyurea use increased 27% among children aged 2–9 years and 23% among children and adolescents aged 10–16 years. However, in 2019, only 47% and 38% of children and adolescents aged 2–9 and 10–16 years, respectively, had received TCD screening and 38% and 53% of children and adolescents aged 2–9 years and 10–16 years, respectively, used hydroxyurea. For both prevention strategies, usage was highest among children and adolescents with high levels of health care utilization and evidence of previous complications indicative of severe disease.

Conclusion and Implications for Public Health Practice: Despite increases since 2014, TCD screening and hydroxyurea use remain low among children and adolescents with SCA. Health care providers should implement quality care strategies within their clinics and partner with patients, families, and community-based organizations to address barriers to delivering and receiving recommended care.

Keywords 
health personnel African Americans medicaid child blood cells

Quick Guide to Primary Care First

Author/s: 
Primary Care First

Primary Care First is a voluntary five-year payment model that rewards value and quality by offering an innovative payment structure to support advanced primary care delivery. Primary Care First aims to improve quality and access to care for all patients, particularly those with complex chronic conditions. The model also aims to reduce Medicare spending by preventing avoidable inpatient hospital admissions.

Keywords 
primary care medicare medicaid PCF primary care first Application

The Primary Cares Initiative: Value-Based Redesign of Primary Care

Author/s: 
Bliss, HE, George, P, Adashi, EY

On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) rolled out the Primary Cares Initiative, a collection of voluntary payment model options in support of high value primary care.1 The first element of the initiative, Primary Care First, is to engage advanced primary care practice sites via two performance-based payment model options.1 The second element of the initiative, Direct Contracting, aims to involve larger primary care entities via three risk-assuming payment model options.

Keywords 
primary care medicare medicaid primary care first payment model

How to generate revenue, improve patient care

Author/s: 
Eramo, L

Adding a behavioral health specialist to your practice can increase practice revenue. This is especially true in areas where behavioral health specialists are not accepting Medicaid. Billable screenings for depression, risk of opioid misuse, or unhealthy alcohol use increase reimbursements. There is a financial risk to small, independent practices and an assessment should be done to consider if revenue increase will cover increased salaries. Practices that have implemented new services offer operational tips to consider for successful integration.

Keywords 
behavioral health revenue practice improvement medicaid

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Author/s: 
Liao, J.M., Navathe, A.S.

Direct provider contracting (DPC) is coming to Medicare. 

Under a new announcement about reforming health care payment and delivery, the Centers for Medicare and Medicaid Services (CMS) has announced forthcoming DPC models as part of the effort to “deliver value-based transformation in primary care.” In particular, the agency seeks to implement models that enable it to directly contract with providers and suppliers and hold them accountable for the cost and quality of care of defined patient populations. Direct contracting shares and extends some features of existing primary care payment reforms, such as an emphasis on financial accountability over outcomes. However, DPC differs from existing primary care payment models primarily by allowing Medicare to contract with providers for a population of beneficiaries’ entire health care spending via global capitated payments. This incorporates approaches from Medicare Advantage (through which Medicare contracts with health plans for beneficiaries’ entire health care spending), while adding flexibility and emphasis on beneficiary choice.

Keywords 
medicare medicaid direct primary care

Lung Cancer Screening: A Clinician’s Checklist

This checklist was developed to help clinicians meet the Centers for Medicare & Medicaid Services (CMS) criteria for a lung cancer screening counseling and shared decisionmaking visit. All of the criteria listed below must be met for the screening to be covered as a preventive service benefit under Medicare.

Lung cancer screening with low-dose computed tomography (LDCT) reduces mortality from lung cancer. There are also potential harms associated with lung cancer screening, including a high-false positive rate and the associated need for diagnostic followup, known and unknown risks of additional testing associated with incidental findings, cumulative radiation exposure, and overdiagnosis. Shared decisionmaking is a collaborative patient-centered process in which patients and clinicians make decisions together, within the context of the best evidence and recommendations and based on the patient’s values and preferences.

Keywords 
lung cancer medicare medicaid

Medical-Legal Partnership

Author/s: 
Legal Aid Services of Oklahoma, Inc.

In Oklahoma, 1 in 5 people live in poverty and also have at least one health-harming civil legal need. Creating a system to screen for these legal needs will allow us to address problems not otherwise attended to, reducing patient stressors and saving health care partner’s money in terms of reducing illness, increasing
adjustment rate payments and reimbursement potential. The Medical-Legal Partnership (MLP) model integrates civil legal aid attorneys in health care teams to address health-harming legal needs for low-income populations.

Keywords 
poverty medicare medicaid legal services
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