Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

Is PC Flex Right for Your ACO?

The Primary Care Flex (PC Flex) model is a new Center for Medicare and Medicaid Innovation (CMMI) model developed to further test how alternative payments for primary care services (PCS) can empower Accountable Care Organizations (ACOs) to use more innovative, team-based, person-centered, and proactive approaches to care that positively impact health care outcomes, quality, and ... Read more

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Week in Washington 06/05/24

MA STARS Lawsuit A federal judge ruled in favor of SCAN Health Plan’s suit against CMS. The suit argued that CMS violated the Administrative Procedures Act (APA) through its application of CMS star ratings calculation, specifically around the Tukey outlier methodology. The ruling could void some of the methodological changes made in 2023. CMS must ... Read more

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Newsworthy Findings

Biden-Harris Administration Expands Access to Mental Health and Substance Use Services with Addition of 10 New States to CCBHC Medicaid Demonstration Program

The CCBHC Medicaid Demonstration Program, which provides states with sustainable funding that helps them expand access to mental health and substance use services, has expanded into 10 new states -- Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island and Vermont.

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Editor's Note
The CCBHC Demonstration Program is created to transform mental health and substance use treatment across the country and provide sustainable funding for robust community outpatient mental health treatment, providing reimbursement through Medicaid for the full cost of services that CCBHCs provide, at higher, more competitive rates than community mental health centers previously received for Medicaid eligible individuals

Medicaid Recipients Struggle To Stay Enrolled

Medicaid — the state-federal health insurance program for low-income and disabled Americans — has cut more than 22 million recipients since spring 2023.

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Editor's Note
After the end of the public health emergency in 2023, the unwinding of Medicaid coverage for millions of eligible Americans has been messy, with qualified individuals losing coverage due the "procedural reasons", aka missing paperwork.

State healthcare cost caps could further pressure hospital operating margins: report

Policies in several states have limited provider rates and levels of reimbursement, as well as constrained operating flexibility, according to Fitch Ratings.

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Editor's Note
The state efforts come amid a nationwide push to lower healthcare costs, including government initiatives reducing surprise billing and negotiating prices of certain prescription drugs.

How 3 digital health companies built sustainable partnerships with employers and health plans

In an increasingly competitive digital health market, it's important for startups to understand what problem health plans and employers are trying to solve and how their solutions can meet those needs, founders say.

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Editor's Note
FarmboxRx now works with about 90 health plans to deliver healthy food boxes while also including education, nudges and reminders to get members involved in managing their care through preventative actions like health screenings and lifestyle improvements.

End of Pandemic Internet Subsidies Threatens a Health Care Lifeline for Rural America

On a reservation in rural southeastern Idaho, about 40% of the 200 households enrolled in the program had no internet before the subsidy. This program brought ease of access to health care, which came to an end last month.

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Editor's Note
The FCC said on May 31 that ending the program will affect about 3.4 million rural and more than 300,000 households in tribal areas.

Bonus Article

Portugal Welcomes First Wild Bison in 10,000 Years–the Keystone Species for Rewilding a Quarter-Million Acres

Rewilding Europe is thrilled to announce the arrival of a small herd of bison in a large valley in Portugal.
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Just for Fun

Math Joke

What do you call a man who spent all summer at the beach?

Prior Week

Q: In a lake, there is a patch of lily pads. Every day, the patch doubles in size. If it takes 48 days for the patch to cover the entire lake, how long would it take for the patch to cover half the lake?
A: The patch doubles in size every day and so on the 47th day the patch will be half the size it is on the 48th day.