Category Archives: Medicare
Vital Healthcare Capital (V-Cap) and the Robert Wood Johnson Foundation (RWJF) have announced a $10 million investment in Commonwealth Care Alliance (CCA), based in Boston, Mass., to help fund the organization as it rapidly expands its model of care for patients who are dually eligible for Medicare and Medicaid.
The non-profit care delivery system provides integrated health care and related social support services for people with complex health care needs covered under Medicaid and for those eligible for both Medicaid and Medicare. CCA’s expansion comes as Massachusetts continues to pioneer integrated, patient-centered care for people who are eligible for both Medicare and Medicaid though the newly created “One Care: MassHealth plus Medicare” program, one of several financial alignment initiatives for people with dual eligibility established by the Affordable Care Act (ACA) that are launching nationwide.
The loan—the first to be made by Vital Healthcare Capital, a new social impact fund based in Boston, through support from RWJF—provides funds needed by CCA for financial reserves required by the Commonwealth of Massachusetts as the agency expands the number of beneficiaries in its programs.
According to CCA Director Robert Master, the social impact goals are to:
- Scale a person-centered integrated care model for high-needs populations.
- Demonstrate what are known in public health as “triple aim” outcomes in health status, care metrics and cost effectiveness.
- Train, develop and create frontline health care workforce jobs, including health aides, drivers and translators.
- Create innovations in health care workforce engagement in coordinated care plans to better integrate into the care plan the staff members who most directly touch the lives of its members.
Over the next five years, Vital Healthcare Capital plans to establish a $100 million revolving loan fund, leveraging $500 million of total project capital for organizations working on health care reform for patients in low-income communities.
NewPublicHealth recently spoke with Steven Weingarten, CEO of Vital Healthcare Capital, about the inaugural loan and the firm’s expansion plans going forward.
NewPublicHealth: How did Vital Healthcare Capital get started and what are its overarching goals and investment criteria?
Steven Weingarten: Vital Healthcare Capital has been formed as a new non-profit financing organization to invest in quality health care and good health care jobs in low-income communities. The organization came about after a couple of years of research and development with funding from the Robert Wood Johnson Foundation, as well as from the Ford and Rockefeller Foundations and support from SEIU, the health care union. Healthcare reform is really part of a broader restructuring of health care that has enormous implications for low-income communities, and for the health care providers and plans that have been focused on these communities. Having financial capital to be able to transform health care to a better delivery model will be a critical challenge in upcoming years. So we are coming in to serve that need.
The Alliance for Health Reform will hold a briefing today in Washington, D.C. on an increasing trend at hospitals of "observing"—instead of admitting—Medicare beneficiaries to hospitals. The briefing follows an AARP report issued earlier this month, Rapid Growth in Medicare Hospital Observation Services: What’s Going On?. The report found that a key reason for the rise in hospital observations among Medicare beneficiaries is that under the Affordable Care Act hospitals can face penalties of 2 percent of hospital charges for patients readmitted to the hospital before thirty days after discharge—which don’t apply if the patient is observed rather than admitted.
Observation status is a long-standing one. For decades it has allowed emergency room staff to determine whether it’s safe for the patient to be sent home. But patients may face higher charges in the emergency room than they would as an inpatient, and may not qualify for Medicare-covered nursing home care after their hospital stay if they were observed and not admitted.
The AARP report analyzed the frequency and duration of the use of observation status for Medicare beneficiaries between 2001 and 2009. It found more than 100 percent growth over nine years, and an even greater percentage increase in the length of time spent in observation, with visits longer than 48 hours increasing the most.
“The dramatic increase in the use of observation status for Medicare patients deserves a closer look,” said Debra Whitman, AARP Executive Vice President for Policy, Strategy and International Affairs. “The clinical benefit of long-term observation remains questionable. And for Medicare patients who remain in the hospital under observation, they may not realize the high out-of-pocket costs they'll have to pay.”
Bipartisan legislation has been introduced in both the House and Senate to count the time spent in observation toward the three-day stay requirement.
>>Bonus Link: The focus of this month’s issue of Health Affairs is the future of emergency medicine.
>>Bonus Content: Follow the briefing on Twitter: #ObservationStatus