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Healthcare Payment Reform and Primary Care Investment Are Key to the Health of Michigan’s Residents
In the last decade, it’s become clear that volume-based payment for healthcare services is a key factor in escalating total health care costs and limitations on healthcare delivery innovation.
Volume-based payments models reimburse solely based on the amount of services rendered, instead of the services or healthcare team members that are most effective in supporting a person’s healthcare needs, and volume-based payment is generally made regardless of the quality of the service provided.
Currently, health centers are paid in the Medicaid program through a Prospective Payment System (PPS) which has some value-based aspects (the PPS uses a single bundled payment for multiple services provided in the same patient encounter) but is still based on the number of traditional patient encounters health centers provide. The PPS’ volume-based structure limits innovation because health centers must design their services around what is reimbursed as a patient encounter, otherwise the services are not sustainable.
As one of the largest networks of healthcare providers serving Medicaid beneficiaries, Michigan’s health centers are committed to collaboratively transforming payment for healthcare services through the adoption of value-based alternative payment methodologies (APM).
MPCA has successfully pushed to put in budget language for the Michigan Department of Health and Human Services to look into adopting an APM and are currently encouraging the Michigan legislature to provide funding for this adoption.
Telehealth Flexibility and Stable Reimbursement are Critical for COVID-19 Recovery and Healthcare Access
Health centers’ experiences during COVID-19 have demonstrated that telehealth services are an effective tool for improving access to care not only during an emergency, but permanently as a healthcare delivery mechanism for patients facing transportation challenges, communities facing healthcare provider shortages, and more. Michigan’s advancements in telehealth services during the COVID-19 pandemic are at risk, however, if the policy and reimbursement flexibilities implemented in 2020 and 2021 are not maintained following the pandemic.
Losing the ability to, for example, provide and be reimbursed for audio-only telehealth services or receiving a lower reimbursement rate for telehealth services than in-person services, would pose significant challenges for health centers and other providers in maintaining telehealth access.
MPCA recommends supporting proposals that would codify current temporary policies regarding telehealth and ensure that health centers and other providers can receive appropriate reimbursement for telehealth services they provide to patients, including reimbursement for audio-only services, covering dental, behavioral and substance use services, and ensuring healthcare providers are not reimbursed at a lower rate than in-person services.
MPCA helped develop and is supporting Senate Bill 1135 in the Michigan Legislature to expand telemedicine services coverage.
Threats to the 340B Drug Pricing Program Represent Critical Risks to Healthcare and Prescription Drug Access
Ensuring access to pharmacy services is an essential part of the health center model and an important aspect of providing high-quality care to the patients health centers serve.
The federal 340B Drug Pricing program provides health centers and other 340B entities access to outpatient drugs at a reduced price. Health centers use the savings from those reduced prices to offer cheaper prescription drugs to eligible patients who don’t have drug coverage and to support other patient services their organization provides, allowing health centers to stretch their scarce resources. While every health center decides how its 340B savings can best benefit its patients, these savings often support clinical pharmacy programs, extended evening and weekend hours, case management services for at-risk community members, and sliding fee discounts for healthcare services– ultimately increasing patient access to care. Currently, however, the 340B program is facing challenges from pharmaceutical manufacturers and other involved entities which limit access to reduced price drugs or make it more difficult for health centers to receive drug savings.
MPCA supports proposals, like the PROTECT 340B Act currently being considered by Congress, to protect the 340b Drug Pricing Program from “pick-pocketing” by Pharmacy Benefit Managers and other entities and ensure that health centers have continued access to these services.
Workforce Development for Federally Qualified Health Care Centers
Pressures from the COVID-19 pandemic, health care workers are leaving the industry at an increasing rate. The health care sector needs further investments in workforce development programs to rebuild workforce staffing levels and retain the existing workforce. This is even more important for health centers, who need to be able to attract talent to underserved areas.
FQHCs continue to serve a vital role in responding to the COVID-19 pandemic through community education, patient testing, and vaccination, while adjusting to stay-at-home orders, drops in patient visits for nonessential care, and workforce challenges.
Centers have experienced staff reductions and financial strains due to the pandemic. This has included an increase in the number of entry-level employees considering other career fields and clinicians considering early retirement due to the stress the pandemic has placed on these employees and the burnout they are now feeling. In fact, two of the largest health centers in Michigan have more than 50 open positions right now with a significant number of those positions being entry level.
MPCA supports funding programs that would alleviate financial barriers to hiring qualified staff at competitive wages, and would provide funding to invest in staff’s training, education, and skills, something that has also been reduced since the COVID-19 pandemic began. This serves as a long-term strategy to prepare a workforce that is engaged, supported, and prepared to act proactively in the face of future challenges.